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General NPI Number Information
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NPI Number | 1720689920
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Entity Type | Individual
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Provider Name | TAMMY LYNN PROHOFSKY APRN, CNP
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Gender | Female
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Dates
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Enumeration Date | 11/04/2020
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Last Update Date | 07/24/2024
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Provider Practice Location Address
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Address Line | 11000 OPTUM CIR
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City | EDEN PRAIRIE
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State | MN
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Zip | 55344-2503
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Country | US
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Telephone | 866-686-2504
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Fax |
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Provider Business Mailing Address
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Address Line | 12490 FAIRBANKS AVE
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City | LONSDALE
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State | MN
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Zip | 55046-4475
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Country | US
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Telephone | 763-257-9280
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 7897
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | R147035-4
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License Number State | MN
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