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General NPI Number Information
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NPI Number | 1083968978
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Entity Type | Individual
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Provider Name | TAMRA R ROBERTSON CPNP
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Gender | Female
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Dates
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Enumeration Date | 10/31/2012
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Last Update Date | 05/09/2016
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Provider Practice Location Address
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Address Line | 350 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5001
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Country | US
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Telephone | 812-335-2434
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Fax | 812-335-7604
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Provider Business Mailing Address
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Address Line | PO BOX 1329
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City | BLOOMINGTON
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State | IN
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Zip | 47402-1329
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Country | US
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Telephone | 812-353-3087
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Fax |
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 71006229A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | 209-009796
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License Number State | IL
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