Healthcare Provider Details

I. General information

NPI: 1780944173
Provider Name (Legal Business Name): TAMMY L SPEERHAS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 08/26/2022
Certification Date: 08/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

817 VOLVO PKWY
CHESAPEAKE VA
23320-2855
US

IV. Provider business mailing address

817 VOLVO PKWY
CHESAPEAKE VA
23320-2855
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-4630
  • Fax: 757-668-4635
Mailing address:
  • Phone: 757-668-4630
  • Fax: 757-668-4635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN562554
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024172501
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: