Healthcare Provider Details

I. General information

NPI: 1346335429
Provider Name (Legal Business Name): TAMMY NISSLY COUGNET CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY NISSLY CRNP

II. Dates (important events)

Enumeration Date: 10/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

827 LINDEN AVE
BALTIMORE MD
21201-4606
US

IV. Provider business mailing address

PO BOX 64522
BALTIMORE MD
21264-4522
US

V. Phone/Fax

Practice location:
  • Phone: 410-225-8000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberR145875
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: