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General NPI Number Information
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NPI Number | 1760120877
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Entity Type | Individual
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Provider Name | TAMMY DIANE DONNICK
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Gender | Female
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Dates
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Enumeration Date | 05/27/2022
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Last Update Date | 06/17/2022
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Provider Practice Location Address
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Address Line | 23 HARBOUR ISLE DR W UNIT PH02
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City | FORT PIERCE
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State | FL
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Zip | 34949-2775
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Country | US
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Telephone | 772-473-6239
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Fax |
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Provider Business Mailing Address
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Address Line | 1715 37TH PL FL 2
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City | VERO BEACH
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State | FL
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Zip | 32960-4508
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Country | US
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Telephone | 772-473-6239
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | APRN11019886
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License Number State | FL
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