Provider Demographics
NPI:1154167724
Name:CONEY, TAMARA KAY (FNP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:KAY
Last Name:CONEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 N 1200 W
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURY
Mailing Address - State:IN
Mailing Address - Zip Code:46540-9372
Mailing Address - Country:US
Mailing Address - Phone:574-825-3888
Mailing Address - Fax:574-318-3358
Practice Address - Street 1:1155 N 1200 W
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:IN
Practice Address - Zip Code:46540-9372
Practice Address - Country:US
Practice Address - Phone:574-825-3888
Practice Address - Fax:574-318-3358
Is Sole Proprietor?:No
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71015467A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily