Healthcare Provider Details

I. General information

NPI: 1841955598
Provider Name (Legal Business Name): TAMMARA S BENJAMIN CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/07/2021
Last Update Date: 01/11/2024
Certification Date: 01/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 CHURCH AVE
NEW HOPE AL
35760-9508
US

IV. Provider business mailing address

3023 LAUREL COVE WAY
GURLEY AL
35748
US

V. Phone/Fax

Practice location:
  • Phone: 256-723-4673
  • Fax:
Mailing address:
  • Phone: 256-323-7011
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number1-154412
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1-154412
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: