Provider Demographics
NPI:1003464165
Name:JURGESS, TAMMY SUE (NP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:SUE
Last Name:JURGESS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:860 HURON CREST DR
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-7908
Mailing Address - Country:US
Mailing Address - Phone:989-315-1497
Mailing Address - Fax:
Practice Address - Street 1:130 MILLWOOD ST
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-1630
Practice Address - Country:US
Practice Address - Phone:989-672-1555
Practice Address - Fax:989-672-1560
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-30
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704242122363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily