Provider Demographics
NPI:1962276840
Name:PAUL, TAMARA ZANDRA (FNP-C)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:ZANDRA
Last Name:PAUL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CENTER WAY
Mailing Address - Street 2:
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2255
Mailing Address - Country:US
Mailing Address - Phone:607-936-9971
Mailing Address - Fax:
Practice Address - Street 1:130 CENTER WAY
Practice Address - Street 2:
Practice Address - City:CORNING
Practice Address - State:NY
Practice Address - Zip Code:14830-2255
Practice Address - Country:US
Practice Address - Phone:607-936-9971
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-10
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP028745363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily