Provider Demographics
NPI:1962415158
Name:JO, TAMARA KARIN (NP)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:KARIN
Last Name:JO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
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Mailing Address - Street 1:450 BROOKLINE AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-5450
Mailing Address - Country:US
Mailing Address - Phone:617-632-5204
Mailing Address - Fax:617-632-3408
Practice Address - Street 1:450 BROOKLINE AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-5450
Practice Address - Country:US
Practice Address - Phone:617-632-5204
Practice Address - Fax:617-632-3408
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA252289363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health