Healthcare Provider Details

I. General information

NPI: 1760869382
Provider Name (Legal Business Name): TAMARA BONSACK CHEATER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2015
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1069 CENTERBROOKE LN
SUFFOLK VA
23434-8475
US

IV. Provider business mailing address

PO BOX 23329
NEW YORK NY
10087-3329
US

V. Phone/Fax

Practice location:
  • Phone: 757-925-1860
  • Fax: 757-925-1863
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024186148
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR157116
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: