MEDICARE: TAMMIE SIMS-RUSSELL

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	95039020	CA

General Provider Information

NPI Number	:	1184434995
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMIE SIMS-RUSSELL

Provider Business Mailing Address
First Line	:	1063 SAN PABLO AVE STE B ROOM # 3
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-2473
Country	:	US
Telephone Number	:	248-979-6373
Fax Number	:

Provider Business Practice Location Address
First Line	:	1063 SAN PABLO AVE STE B ROOM # 3
Second Line	:
City	:	PINOLE
State	:	CA
Zip	:	94564-2473
Country	:	US
Telephone Number	:	248-979-6373
Fax Number	:

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

Provider Enumeration Date	:	01/13/2025
Last Update Date	:	03/16/2026

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Directions to “ TAMMIE SIMS-RUSSELL ” Practice Location

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