Provider Demographics
NPI:1841629722
Name:HARROLD, TAMAKI ANNE (CNP)
Entity type:Individual
Prefix:
First Name:TAMAKI
Middle Name:ANNE
Last Name:HARROLD
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:KIA TAMAKI
Other - Middle Name:
Other - Last Name:HARROLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 290
Mailing Address - Street 2:
Mailing Address - City:QUESTA
Mailing Address - State:NM
Mailing Address - Zip Code:87556-0290
Mailing Address - Country:US
Mailing Address - Phone:575-586-0315
Mailing Address - Fax:575-586-0519
Practice Address - Street 1:2573 STATE HWY 522
Practice Address - Street 2:
Practice Address - City:QUESTA
Practice Address - State:NM
Practice Address - Zip Code:87556
Practice Address - Country:US
Practice Address - Phone:575-586-3015
Practice Address - Fax:575-586-0519
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-01
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0000139-C-NP363LF0000X
NMCNP02406363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily