MEDICARE: TAMMY WARD GIPPS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH6013	FL

General Provider Information

NPI Number	:	1114623287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY WARD GIPPS

Provider Business Mailing Address
First Line	:	2149 NE 61ST CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-2155
Country	:	US
Telephone Number	:	954-257-5034
Fax Number	:

Provider Business Practice Location Address
First Line	:	2149 NE 61ST CT
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-2155
Country	:	US
Telephone Number	:	954-257-5034
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2023
Last Update Date	:	02/01/2023

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Directions to “ TAMMY WARD GIPPS ” Practice Location

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