Brendalyne Facia Tamba, FNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

RN207407 Issued in GA

Practice address

361 Resource Pkwy
Winder, GA 30680-8364

Phone

(770) 291-0419

Fax

(240) 348-8500

NPI assigned

Sep 6, 2020

Last updated

Jan 13, 2021By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Georgia Nephrology, LLCGroup PAC ID 4082606496, 29 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: btamba30552@direct.acumenmd.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Georgia Nephrology, LLC

  • Nephrology Physician
  • Decatur, GA
  • NPI 1063422723

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Ivydale Wellness Center LLC

  dba Ivydale Wellness Clinic

  • Community/Behavioral Health Agency
  • Winder, GA
  • NPI 1326653783

  Single Specialty

  NPD
• Ivydale Wellness Center LLC

  dba Ivydale Wellness Center

  • Psychiatric/Mental Health Nurse Practitioner
  • Winder, GA
  • NPI 1659919066

  Single Specialty

  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1599350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1610496000000",
    "number": "1053925107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "595 HURRICANE SHOALS RD NW",
            "address_2": "STE 100",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300468762",
            "telephone_number": "404-645-7150",
            "fax_number": "678-433-9152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "361 RESOURCE PKWY",
            "city": "WINDER",
            "state": "GA",
            "postal_code": "306808364",
            "telephone_number": "770-291-0419",
            "fax_number": "240-348-8500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAMBA",
        "first_name": "BRENDALYNE",
        "middle_name": "FACIA",
        "credential": "FNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-09-06",
        "last_updated": "2021-01-13",
        "certification_date": "2021-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "GA",
            "license": "RN207407",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kia'Ra Stewart
• Mallory Bentley Still, PHARMD
• Jasson Sutton
• Stephaine Tabb
• Altaf Husain Tadkod, M.D., M.P.H.
• Poppy M Tansey, NP
• Sharon Lyle Taylor, M.D.
• Jordan Leigh Thackston, FNP-C
• Xue Thao, PHARM.D.
• The Abundant Life Institute Inc

• Family Nurse Practitioner in Winder, GA
• Providers in Winder, GA by specialty
• Family Nurse Practitioner in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.