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NPI Code Detail

MEDICARE: TAMMY VINCENT

MEDICARE: TAMMY VINCENT
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
1363LA2100XAcute Care Nurse PractitionerR872175MS

General Provider Information

NPI Number : 1295107357
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMMY VINCENT
Provider Business Mailing Address
First Line : 422 MEMORIAL BLVD
Second Line :
City : PICAYUNE
State : MS
Zip : 39466-5544
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 14116 CUSTOMS BLVD
Second Line :
City : GULFPORT
State : MS
Zip : 39503-5164
Country : US
Telephone Number : 601-957-6300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/28/2015
Last Update Date : 10/25/2019

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Directions to “ TAMMY VINCENT ” Practice Location

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