Healthcare Provider Details

I. General information

NPI: 1184665796
Provider Name (Legal Business Name): TAMMY ABBOTT HERUBIN CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 03/19/2025
Certification Date: 03/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8600 N STATE ROUTE 91 SUITE 250
PEORIA IL
61615-9541
US

IV. Provider business mailing address

5040 SOUTHERN PINE CIR
VENICE FL
34293-4259
US

V. Phone/Fax

Practice location:
  • Phone: 309-692-5394
  • Fax:
Mailing address:
  • Phone: 309-339-1274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1837352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: