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General NPI Number Information
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NPI Number | 1063774875
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Entity Type | Individual
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Provider Name | TAMARA EYVETTE TOMLIN ANP-BC
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Gender | Female
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Dates
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Enumeration Date | 06/08/2012
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Last Update Date | 03/11/2025
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Provider Practice Location Address
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Address Line | 915 N GRAND BLVD
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City | SAINT LOUIS
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State | MO
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Zip | 63106-1621
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Country | US
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Telephone | 314-652-4100
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Fax | 314-289-7034
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Provider Business Mailing Address
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Address Line | 5064 RAYMOND AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63113-1629
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Country | US
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Telephone | 314-941-1242
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Fax | 314-289-7034
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 2012009897
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License Number State | MO
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