Provider Demographics
NPI:1386764116
Name:TAMBURRINO, HEATHER (PA-C)
Entity type:Individual
Prefix:
First Name:HEATHER
Middle Name:
Last Name:TAMBURRINO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:911 N BUFFALO DR
Mailing Address - Street 2:UNIT 113
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0380
Mailing Address - Country:US
Mailing Address - Phone:586-229-7812
Mailing Address - Fax:231-241-1109
Practice Address - Street 1:911 N BUFFALO DR UNIT 113
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0380
Practice Address - Country:US
Practice Address - Phone:702-960-4441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601004975363A00000X
CA53283363A00000X
NVPA1390363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVPA1390OtherNSBME
NVCS20630OtherNV PHARMACY
1386764116OtherNPI
MI5601004975OtherMICHIGAN LARA
NVGW483ZOtherMEDICARE
NVPA1390OtherSTATE OF NV BOARD OF MEDICAL EXAMINERS
NVPA1390OtherSTATE OF NV BOARD OF MEDICAL EXAMINERS