Provider Demographics
NPI:1316006794
Name:TUCKER-HAM, TAMARA J (NP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:J
Last Name:TUCKER-HAM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2369
Mailing Address - Street 2:
Mailing Address - City:BORREGO SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92004-2369
Mailing Address - Country:US
Mailing Address - Phone:760-767-5051
Mailing Address - Fax:
Practice Address - Street 1:133 W MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-3325
Practice Address - Country:US
Practice Address - Phone:619-401-0404
Practice Address - Fax:619-401-0522
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANFP9100363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMT0561983OtherDEA