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General NPI Number Information
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NPI Number | 1740621838
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Entity Type | Individual
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Provider Name | TAMAR MICHELLE BROUSSARD PA, MPH
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Gender | Female
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Dates
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Enumeration Date | 07/17/2013
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Last Update Date | 10/07/2023
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Provider Practice Location Address
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Address Line | 8233 E STOCKTON BLVD STE D
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City | SACRAMENTO
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State | CA
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Zip | 95828-8203
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Country | US
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Telephone | 916-368-3080
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Fax |
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Provider Business Mailing Address
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Address Line | 8233 E STOCKTON BLVD STE D
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City | SACRAMENTO
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State | CA
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Zip | 95828-8203
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Country | US
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Telephone | 916-368-3080
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA23022
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA060105
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 25MP00492300
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License Number State | NJ
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