Provider Demographics
NPI:1023395233
Name:COCOLA, TAMMY LEIGH (PA-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LEIGH
Last Name:COCOLA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:LEIGH
Other - Last Name:HASSAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23501-0936
Mailing Address - Country:US
Mailing Address - Phone:757-446-7979
Mailing Address - Fax:757-446-8907
Practice Address - Street 1:825 FAIRFAX AVE STE 310
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1914
Practice Address - Country:US
Practice Address - Phone:757-446-7979
Practice Address - Fax:757-446-8907
Is Sole Proprietor?:No
Enumeration Date:2011-11-16
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003345363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1023395233Medicaid
1023395233OtherMULTIPLAN