Provider Demographics
NPI:1295945533
Name:DYKSTRA, TAMARA L (ARNP)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:L
Last Name:DYKSTRA
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2671 NE KEVOS POND DR
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8536
Mailing Address - Country:US
Mailing Address - Phone:360-779-7882
Mailing Address - Fax:
Practice Address - Street 1:9951 MICKELBERRY RD NW
Practice Address - Street 2:SUITE 101
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-8309
Practice Address - Country:US
Practice Address - Phone:360-692-9362
Practice Address - Fax:360-692-6214
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP30006643363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics