Individual
TAMARA S IVANOVA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
612 KINGSBOROUGH SQ STE 100, CHESAPEAKE, VA 23320-5041
(757) 547-9294
(757) 213-9342
Mailing address
PO BOX 7068, PORTSMOUTH, VA 23707-0068
(757) 686-3516
(757) 686-0230
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024181213
VA
363LF0000X
Family Nurse Practitioner
5011406
NC
Other
Enumeration date
01/30/2019
Last updated
12/20/2021
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