Healthcare Provider Details

I. General information

NPI: 1477413367
Provider Name (Legal Business Name): TAMARA MICHELLE ROBERTSON FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2025
Last Update Date: 11/13/2025
Certification Date: 11/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1075 N FRASER ST
GEORGETOWN SC
29440-2848
US

IV. Provider business mailing address

47 SWAMP FOX LN
GEORGETOWN SC
29440-7613
US

V. Phone/Fax

Practice location:
  • Phone: 843-527-4442
  • Fax:
Mailing address:
  • Phone: 843-252-4590
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number31136
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: