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General NPI Number Information
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NPI Number | 1356336812
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Entity Type | Individual
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Provider Name | TAMMY G PRUSE DO
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Gender | Female
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Dates
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Enumeration Date | 09/12/2005
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Last Update Date | 08/20/2025
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Provider Practice Location Address
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Address Line | 3874 HIGHWAY 90 STE 101
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City | PACE
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State | FL
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Zip | 32571-1014
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Country | US
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Telephone | 850-908-2315
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Fax | 850-908-2307
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Provider Business Mailing Address
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Address Line | PO BOX 95590
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City | SOUTH JORDAN
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State | UT
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Zip | 84095-0590
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Country | US
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Telephone | 801-352-9500
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Fax | 801-352-7976
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS 8320
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License Number State | FL
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