Provider Demographics
NPI:1316270523
Name:PINTO, TAMARA L (NP-C)
Entity type:Individual
Prefix:MS
First Name:TAMARA
Middle Name:L
Last Name:PINTO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:LYN
Other - Last Name:HAWKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 N NILES AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46617-1924
Mailing Address - Country:US
Mailing Address - Phone:574-647-1610
Mailing Address - Fax:
Practice Address - Street 1:306 E VISTULA ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:IN
Practice Address - Zip Code:46507-9489
Practice Address - Country:US
Practice Address - Phone:574-848-4427
Practice Address - Fax:574-848-4592
Is Sole Proprietor?:No
Enumeration Date:2009-09-08
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71003030A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
INP01316603OtherRR MEDICARE
IN200955940Medicaid
IN000000851206OtherBCBS BMG GOSHEN
IN000000911646OtherBCBS BMG ELKHART EAST
IN000000725995OtherANTHEM - WMC
IN000000727660OtherANTHEM - FMC
INP01316603OtherRR MEDICARE
IN000000725998OtherANTHEM - BMA
IN259090BMedicare PIN
IN000000851206OtherBCBS BMG GOSHEN
INP01316603OtherRR MEDICARE
IN000000725998OtherANTHEM - BMA
IN000000725995OtherANTHEM - WMC
INM400054673 FWOMedicare PIN
IN236040073Medicare PIN