Healthcare Provider Details

I. General information

NPI: 1518992056
Provider Name (Legal Business Name): TAMMY JOY COLAIZZO CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY J SMITH CRNA

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/25/2025
Certification Date: 06/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W MARKET STREET
LIMA OH
45801
US

IV. Provider business mailing address

PO BOX 71-0776
COLUMBUS OH
43271-0776
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-3361
  • Fax:
Mailing address:
  • Phone: 419-228-1506
  • Fax: 419-228-3352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN322494
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberRN505472L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: