Provider Demographics
NPI:1699535260
Name:MURKLE, TAMY JO (BA, MA)
Entity type:Individual
Prefix:MS
First Name:TAMY
Middle Name:JO
Last Name:MURKLE
Suffix:
Gender:F
Credentials:BA, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:961 W CREEKBURY ST
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:ID
Mailing Address - Zip Code:83646-3143
Mailing Address - Country:US
Mailing Address - Phone:208-954-6895
Mailing Address - Fax:
Practice Address - Street 1:6305 W OVERLAND RD
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83709-3029
Practice Address - Country:US
Practice Address - Phone:208-605-3663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker