Provider Demographics
NPI:1316665706
Name:NICHOLS-BARBA, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:NICHOLS-BARBA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 S INDEPENDENCE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-1152
Mailing Address - Country:US
Mailing Address - Phone:757-613-8738
Mailing Address - Fax:
Practice Address - Street 1:520 S INDEPENDENCE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1152
Practice Address - Country:US
Practice Address - Phone:757-613-8738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-22
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA88-3805531Medicaid