Provider Demographics
NPI:1336431550
Name:WHITE, TAMRA LEIGH (RN)
Entity type:Individual
Prefix:MRS
First Name:TAMRA
Middle Name:LEIGH
Last Name:WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1241 ROWLAND DR
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-2430
Mailing Address - Country:US
Mailing Address - Phone:301-788-1529
Mailing Address - Fax:
Practice Address - Street 1:1062 ELDEN ST
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-3803
Practice Address - Country:US
Practice Address - Phone:703-471-7000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR145155163W00000X
VA0001255433363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse