Healthcare Provider Details

I. General information

NPI: 1477225837
Provider Name (Legal Business Name): TAMARA KHAZBIEVA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2021
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 N 5TH AVE
SEQUIM WA
98382-3045
US

IV. Provider business mailing address

PO BOX 850
PORT ANGELES WA
98362-0146
US

V. Phone/Fax

Practice location:
  • Phone: 360-683-9895
  • Fax: 360-582-5614
Mailing address:
  • Phone: 360-683-9895
  • Fax: 360-582-5614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP61306927
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704289310
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: