MEDICARE: TAMARA CRUMP ANDERSON FNP-C

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	363LF0000X	Family Nurse Practitioner	0024177044	VA

General Provider Information

NPI Number	:	1508330234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMARA CRUMP ANDERSON FNP-C

Provider Business Mailing Address
First Line	:	13180 MIDLOTHIAN TPKE
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-4245
Country	:	US
Telephone Number	:	804-379-9060
Fax Number	:

Provider Business Practice Location Address
First Line	:	13180 MIDLOTHIAN TPKE # 1459
Second Line	:
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23113-4245
Country	:	US
Telephone Number	:	804-379-9060
Fax Number	:

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

Provider Enumeration Date	:	01/16/2019
Last Update Date	:	06/03/2021

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