=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922780329
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMY LYNN HAHN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/04/2023
-----------------------------------------------------
Last Update Date | 11/16/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 13031 WYANDOTTE RD
-----------------------------------------------------
City | GIBSONTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33534-5833
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-630-6943
-----------------------------------------------------
Fax | 813-635-1796
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 802 BLACK KNIGHT DR
-----------------------------------------------------
City | VALRICO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33594-6601
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-990-9253
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11027865
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LX0106X
-----------------------------------------------------
Taxonomy Name | Occupational Health Nurse Practitioner
-----------------------------------------------------
License Number | APRN11027865
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------