=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316270523
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMARA L PINTO NP-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2009
-----------------------------------------------------
Last Update Date | 03/31/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 306 E VISTULA ST
-----------------------------------------------------
City | BRISTOL
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46507-9489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-848-4427
-----------------------------------------------------
Fax | 574-848-4592
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 710 N NILES AVE
-----------------------------------------------------
City | SOUTH BEND
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46617-1924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 574-647-1610
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 71003030A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------