Provider Demographics
NPI:1053739706
Name:LOY, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:LOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 PIONEER LN
Mailing Address - Street 2:STE H
Mailing Address - City:BISHOP
Mailing Address - State:CA
Mailing Address - Zip Code:93514-2563
Mailing Address - Country:US
Mailing Address - Phone:248-577-3511
Mailing Address - Fax:248-577-3526
Practice Address - Street 1:44201 DEQUINDRE RD
Practice Address - Street 2:BEAUMONT EMERGENCY SERVICES
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1117
Practice Address - Country:US
Practice Address - Phone:248-964-5111
Practice Address - Fax:248-964-5068
Is Sole Proprietor?:No
Enumeration Date:2014-03-31
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704301265363L00000X
CA95000071363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner