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General NPI Number Information
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NPI Number | 1184665796
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Entity Type | Individual
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Provider Name | TAMMY ABBOTT HERUBIN CRNA
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Gender | Female
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 03/19/2025
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Provider Practice Location Address
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Address Line | 8600 N STATE ROUTE 91 SUITE 250
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City | PEORIA
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State | IL
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Zip | 61615-9541
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Country | US
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Telephone | 309-692-5394
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Fax |
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Provider Business Mailing Address
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Address Line | 5040 SOUTHERN PINE CIR
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City | VENICE
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State | FL
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Zip | 34293-4259
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Country | US
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Telephone | 309-339-1274
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | ARNP1837352
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License Number State | FL
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