Provider Demographics
NPI:1427474949
Name:BRADY, TAMARA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:MARIE
Last Name:BRADY
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 1:1141 PEAR TREE LN STE 100
Mailing Address - Street 2:
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6485
Mailing Address - Country:US
Mailing Address - Phone:072-541-7707
Mailing Address - Fax:
Practice Address - Street 1:300 HARTLE CT
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-4078
Practice Address - Country:US
Practice Address - Phone:707-254-1775
Practice Address - Fax:707-254-1779
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51433363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical