MEDICARE: TAMMI LORRAINE HARRIS N.P

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	363LG0600X	Gerontology Nurse Practitioner	14292	CA

General Provider Information

NPI Number	:	1215256011
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMI LORRAINE HARRIS N.P

Provider Business Mailing Address
First Line	:	4911 VAN NUYS BLVD
Second Line	:	SUITE 307
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-1716
Country	:	US
Telephone Number	:	818-981-7111
Fax Number	:

Provider Business Practice Location Address
First Line	:	9233 W PICO BLVD
Second Line	:	SUITE 220
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-1386
Country	:	US
Telephone Number	:	310-356-8146
Fax Number	:	818-356-8142

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

Provider Enumeration Date	:	05/19/2010
Last Update Date	:	03/12/2016

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