Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | APRN002055 | NV |
NPI | 1003253881 |
---|---|
Provider Name | Tamaris Samantha Cotta |
First Address | Las Vegas, NV 89148-1319 |
Second Address | Las Vegas, NV 89104-3842 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/06/2013 |
Last Update Date | 10/11/2020 |