Healthcare Provider Details

I. General information

NPI: 1124427687
Provider Name (Legal Business Name): TAMMY L MCCOY CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2014
Last Update Date: 09/12/2023
Certification Date: 09/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15655 STATE ROUTE 170 STE A
EAST LIVERPOOL OH
43920-9672
US

IV. Provider business mailing address

2000 CLIFFMINE RD PKW #2, STE #110
PITTSBURGH PA
15275-1008
US

V. Phone/Fax

Practice location:
  • Phone: 330-386-4303
  • Fax: 216-229-2630
Mailing address:
  • Phone: 412-494-4550
  • Fax: 412-494-4551

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberSP014087
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number021464
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: