Healthcare Provider Details

I. General information

NPI: 1366177438
Provider Name (Legal Business Name): TAMMY LYNN HERRERA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/21/2022
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 E INDIAN SCHOOL RD
PHOENIX AZ
85012-1839
US

IV. Provider business mailing address

200 TREVISO GRAND CIR UNIT 206
NOKOMIS FL
34275-3262
US

V. Phone/Fax

Practice location:
  • Phone: 602-277-5551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9535995
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: