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NPI Code Detail

MEDICARE: TAMMY TATE-GOBERT ANP-C

MEDICARE: TAMMY TATE-GOBERT ANP-C
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
1363L00000XNurse PractitionerAPO4589LA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00214394OTHERLARRMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1508816968
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY TATE-GOBERT ANP-C
Provider Business Mailing Address
First Line : PO BOX 1395
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70602-1395
Country : US
Telephone Number : 337-494-2121
Fax Number : 337-494-2360
Provider Business Practice Location Address
First Line : 1701 OAK PARK BLVD
Second Line :
City : LAKE CHARLES
State : LA
Zip : 70601-8911
Country : US
Telephone Number : 337-494-2121
Fax Number : 337-494-2360
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2006
Last Update Date : 06/17/2022

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