Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Tamarra Lynn Subyantoro, APN

Individual provider Family Nurse Practitioner · NPI 1942842018

Tamarra Lynn Subyantoro, APN is a Nurse Practitioner in Peoria, Illinois. Qualified in 2019, 7 years ago. Practices with Osf Multi-Specialty Group, a 2,128-clinician group and accepts Medicare assignment. Licensed in Illinois.

Years since qualifying
7
Licensed in
IL
In the registry since
2019
Specialties on file
2
What do these letters mean?
APN — Advanced Practice Nurse
The umbrella title some states use for nurse practitioners and other advanced practice nurses.

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Practice location Address checks out

5114 N Glen Park Place Rd Ste 110
Peoria, IL 61614-4686
Phone: (309) 683-5600
Fax: (309) 683-5607
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Nurse Practitioner (primary) Taxonomy 363LF0000X · Licence 209019900 (IL)
Nurse Practitioner Taxonomy 363L00000X · Licence 209019900 (IL)

Record details

NPI number1942842018
Entity typeIndividual (Type 1)
GenderFemale
Credentials APN
Sole proprietorNo
NPI enumeratedOctober 10, 2019
Last updated in NPPESSeptember 27, 2024
Certification dateSeptember 27, 2024

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2019 (7 years in practice)
Group practice Osf Multi-Specialty Group — 2128 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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