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General NPI Number Information
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NPI Number | 1942278213
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Entity Type | Individual
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Provider Name | TAMMY JO GUSTIN CNP
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Gender | Female
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Dates
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Enumeration Date | 03/10/2006
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Last Update Date | 06/11/2009
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Provider Practice Location Address
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Address Line | 421 S CAMPUS AVE
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City | OXFORD
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State | OH
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Zip | 45056-2487
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Country | US
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Telephone | 513-529-3000
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Fax | 513-529-1892
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Provider Business Mailing Address
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Address Line | 262 TAMARACK TRL
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City | SPRINGBORO
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State | OH
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Zip | 45066-1469
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Country | US
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Telephone | 937-748-1661
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | NP-05271
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License Number State | OH
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