MEDICARE: TAMARA SMITH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3747P1801X	Personal Care Attendant
2	376K00000X	Nurse's Aide

General Provider Information

NPI Number	:	1083278139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA SMITH

Provider Business Mailing Address
First Line	:	PO BOX 49622
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80949-9622
Country	:	US
Telephone Number	:	949-501-6384
Fax Number	:

Provider Business Practice Location Address
First Line	:	5940 NORA PT APT 103
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80919-3735
Country	:	US
Telephone Number	:	949-501-6384
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2019
Last Update Date	:	04/24/2019

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Directions to “ TAMARA SMITH ” Practice Location

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