Provider Demographics
NPI:1053122697
Name:SMITH, TAMARA MARIE ANN (RN,BSN, NC-BC)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:MARIE ANN
Last Name:SMITH
Suffix:
Gender:F
Credentials:RN,BSN, NC-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6109 MARY LEWIS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78747-2773
Mailing Address - Country:US
Mailing Address - Phone:903-431-8033
Mailing Address - Fax:
Practice Address - Street 1:6109 MARY LEWIS DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78747-2773
Practice Address - Country:US
Practice Address - Phone:903-431-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-14
Last Update Date:2025-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1022945163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse