MEDICARE: TAMMY DITTA APRN, FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	216052	LA

General Provider Information

NPI Number	:	1043815426
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY DITTA APRN, FNP

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	318-450-4626
Fax Number	:

Provider Business Practice Location Address
First Line	:	3424 CYPRESS ST
Second Line	:
City	:	WEST MONROE
State	:	LA
Zip	:	71291-7310
Country	:	US
Telephone Number	:	318-450-4626
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/02/2020
Last Update Date	:	03/05/2026

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