Provider Demographics
NPI:1043304967
Name:HENIGAN, TAMYRA (CFNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMYRA
Middle Name:
Last Name:HENIGAN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:573 N BRADLEY HWY
Mailing Address - Street 2:
Mailing Address - City:ROGERS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49779-1508
Mailing Address - Country:US
Mailing Address - Phone:989-734-2171
Mailing Address - Fax:989-734-2312
Practice Address - Street 1:573 N BRADLEY HWY
Practice Address - Street 2:
Practice Address - City:ROGERS CITY
Practice Address - State:MI
Practice Address - Zip Code:49779-1508
Practice Address - Country:US
Practice Address - Phone:989-734-2171
Practice Address - Fax:989-734-2312
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704171541363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner