MEDICARE: TAMMY SPENCER RN, ACNS-BC, CCNS

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	163WC0200X	Critical Care Medicine Registered Nurse	APN.0100007	CO
2	163WC0200X	Critical Care Medicine Registered Nurse	0084345	CO

General Provider Information

NPI Number	:	1598163370
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY SPENCER RN, ACNS-BC, CCNS

Provider Business Mailing Address
First Line	:	128 IVY ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80220-5847
Country	:	US
Telephone Number	:	303-377-2649
Fax Number	:

Provider Business Practice Location Address
First Line	:	13120 E 19TH AVE
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80045-2567
Country	:	US
Telephone Number	:	303-724-8529
Fax Number	:

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

Provider Enumeration Date	:	12/10/2014
Last Update Date	:	12/10/2014

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