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General NPI Number Information
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NPI Number | 1225730526
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Entity Type | Individual
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Provider Name | TAMARA HEAD RN, APRN-CNP
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Gender | Female
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Dates
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Enumeration Date | 03/20/2023
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Last Update Date | 03/20/2023
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Provider Practice Location Address
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Address Line | 200 O CONNOR RIDGE BLVD STE 100
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City | IRVING
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State | TX
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Zip | 75038-6513
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Country | US
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Telephone | 214-300-8331
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Fax |
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Provider Business Mailing Address
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Address Line | 104 FOSSIL WAY
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City | ALVARADO
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State | TX
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Zip | 76009-2659
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Country | US
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Telephone |
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 1113001
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License Number State | TX
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