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General NPI Number Information
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NPI Number | 1205891785
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Entity Type | Individual
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Provider Name | TAMMY MICHELLE HALEY CRNP
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Gender | Female
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Dates
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Enumeration Date | 04/19/2006
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Last Update Date | 10/22/2014
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Provider Practice Location Address
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Address Line | 70 1/2 MECHANIC STREET
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City | BRADFORD
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State | PA
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Zip | 16701
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Country | US
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Telephone | 814-368-6129
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Fax | 814-368-6174
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Provider Business Mailing Address
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Address Line | 70 1/2 MECHANIC STREET
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City | BRADFORD
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State | PA
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Zip | 16701
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Country | US
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Telephone | 814-368-6129
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Fax | 814-368-6174
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | SP007465
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License Number State | PA
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