MEDICARE: TAMMY VANN ARNP

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	363LP2300X	Primary Care Nurse Practitioner	9254608	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417476714
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY VANN ARNP

Provider Business Mailing Address
First Line	:	203 PINE HAVEN DR
Second Line	:
City	:	SAINT JOHNS
State	:	FL
Zip	:	32259-7403
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5964 NORMANDY BLVD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32205-6212
Country	:	US
Telephone Number	:	904-378-0121
Fax Number	:

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

Provider Enumeration Date	:	09/18/2017
Last Update Date	:	01/16/2023

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