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General NPI Number Information
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NPI Number | 1477413367
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Entity Type | Individual
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Provider Name | TAMARA MICHELLE ROBERTSON FNP
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Gender | Female
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Dates
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Enumeration Date | 11/13/2025
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 1075 N FRASER ST
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City | GEORGETOWN
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State | SC
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Zip | 29440-2848
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Country | US
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Telephone | 843-527-4442
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Fax |
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Provider Business Mailing Address
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Address Line | 47 SWAMP FOX LN
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City | GEORGETOWN
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State | SC
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Zip | 29440-7613
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Country | US
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Telephone | 843-252-4590
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 31136
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License Number State | SC
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