Healthcare Provider Details

I. General information

NPI: 1871420620
Provider Name (Legal Business Name): TAMMY GRANVILLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2026
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

986 WOODVINE DR
BATON ROUGE LA
70806-9234
US

IV. Provider business mailing address

986 WOODVINE DR
BATON ROUGE LA
70806-9234
US

V. Phone/Fax

Practice location:
  • Phone: 225-993-4835
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: