Individual
TAMARA LYNN BROADHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
10294 S ROYAL VISTA CV, SOUTH JORDAN, UT 84095-3045
(817) 319-9475
Mailing address
10294 S ROYAL VISTA CV, SOUTH JORDAN, UT 84095-3045
(817) 319-9475
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
7096258-4405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
7096258-4405
UT
Other
Enumeration date
06/26/2017
Last updated
09/28/2022
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