Provider Demographics
NPI:1013544063
Name:TMG MEDICAL MANAGEMENT
Entity Type:Organization
Organization Name:TMG MEDICAL MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRISHAM
Authorized Official - Suffix:
Authorized Official - Credentials:ARPN
Authorized Official - Phone:954-448-3913
Mailing Address - Street 1:714 NW LEONARDO CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-4354
Mailing Address - Country:US
Mailing Address - Phone:954-448-3913
Mailing Address - Fax:
Practice Address - Street 1:714 NW LEONARDO CIR
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-4354
Practice Address - Country:US
Practice Address - Phone:954-448-3913
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-26
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty