Healthcare Provider Details

I. General information

NPI: 1922414408
Provider Name (Legal Business Name): TAMMY JO COCHRANE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TAMMY JO MILLER

II. Dates (important events)

Enumeration Date: 07/07/2014
Last Update Date: 05/16/2023
Certification Date: 05/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 CEDAR ST
OROFINO ID
83544
US

IV. Provider business mailing address

301 CEDAR ST
OROFINO ID
83544-9029
US

V. Phone/Fax

Practice location:
  • Phone: 208-476-4555
  • Fax: 208-476-5385
Mailing address:
  • Phone: 208-476-4555
  • Fax: 208-476-5385

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-1448A
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: