MEDICARE: TAMMY SUZANNE ROBERTSON RN PCCNP

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	363LP0222X	Critical Care Pediatric Nurse Practitioner	568448	TX

General Provider Information

NPI Number	:	1669561924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY SUZANNE ROBERTSON RN PCCNP

Provider Business Mailing Address
First Line	:	3605 BANKS CIR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-3849
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3605 BANKS CIR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75025-3849
Country	:	US
Telephone Number	:	972-335-0006
Fax Number	:

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	07/08/2007

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