Healthcare Provider Details

I. General information

NPI: 1144238965
Provider Name (Legal Business Name): TAMARA K TJEPKEMA CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2006
Last Update Date: 09/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 HARBOUR VIEW BLVD SUITE 240
SUFFOLK VA
23435-3315
US

IV. Provider business mailing address

P.O. BOX 37090
BALTIMORE MD
21297-3090
US

V. Phone/Fax

Practice location:
  • Phone: 757-483-6100
  • Fax: 703-295-9369
Mailing address:
  • Phone: 703-295-9360
  • Fax: 703-295-9369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number0024164601
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: