TAMARA LYNN BROADHEAD (APRN) – Psychiatric/Mental Health Nurse Practitioner, NPI 1124548789

TAMARA LYNN BROADHEAD (APRN) is a healthcare provider. based in South jordan, Utah. specializing in NURSE PRACTITIONER. They hold the professional credentials APRN. They hold a License No. 7096258-4405 (UT). The NPI Number for TAMARA LYNN BROADHEAD (APRN) is 1124548789

Main info

Female
9 Years Of Experience
Accepts Medicare Assignment
Name
TAMARA LYNN BROADHEAD (APRN)
NPI
1124548789
Phone
(817) 319-9475
Address
10294 S ROYAL VISTA CV
Enumeration Date
26 June 2017
Last Update Date
28 September 2022

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8012649522
Graduation Year
2017 (9 years ago)
PAC ID
4183981665
Group Practice PAC ID
7719325083
Professional Enrollment ID
I20171208002076
Address ID
UT841074246MU310XX4500301
Telehealth
Yes
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience45
Completeness75
Years active:8State licenses:1Digital endpointsOther names

2,655 NURSE PRACTITIONER in UT

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Provider Addresses for TAMARA LYNN BROADHEAD (APRN)

  • 10294, South Royal Vista Cove, Wheadon Acres, South Jordan, Salt Lake County, Utah, 84095, United States

    SOUTH JORDAN, UT 840953045

    Phone: (817) 319-9475

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 66 Open Payments records for all available years, with a total value of $1,241.

Total Amount is formed as General ($1,241) + Research ($0) + Ownership ($0) = $1,241.

Last reported payment date: 2024-12-18 • Largest payer in this snapshot: ABBVIE INC. ($441).

Total Amount

$1,241

General + Research + Ownership

Payments

66

Total payment records

General Amount

$1,241

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-18

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2017-12-08

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20171208002076INurse PractitionerUTTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 84095)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 7719325083View full group profile
NameSpecialtyState
Mental Health CounselorOH
Clinical PsychologistOH
Mental Health CounselorOH
Mental Health CounselorOH
Marriage And Family TherapistHI
Mental Health CounselorOH
Mental Health CounselorOH
Mental Health CounselorUT
Clinical Social WorkerOH
Clinical Social WorkerUT

Reviews

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Frequently asked questions

What unique ID ties claims to TAMARA LYNN BROADHEAD (APRN)?
NPI 1124548789 is assigned to TAMARA LYNN BROADHEAD (APRN) under the national enumeration system.
Does this profile mean TAMARA LYNN BROADHEAD (APRN) is currently active?
Yes — TAMARA LYNN BROADHEAD (APRN) appears active in the national provider directory.
Can you summarize TAMARA LYNN BROADHEAD (APRN)'s specialty in plain language?
Clinically, the directory lists TAMARA LYNN BROADHEAD (APRN) with Psychiatric/Mental Health Nurse Practitioner. Clinical services aligned with this taxonomy classification.
What location metadata exists for TAMARA LYNN BROADHEAD (APRN)?
The page summarizes South Jordan, Utah for TAMARA LYNN BROADHEAD (APRN); expand the address list for detail.
How can I contact TAMARA LYNN BROADHEAD (APRN)?
Phone or fax may appear on the official NPI record when supplied — verify before relying on them.

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