Provider Demographics
NPI:1083061550
Name:PHIPPS, TAMMERA
Entity Type:Individual
Prefix:
First Name:TAMMERA
Middle Name:
Last Name:PHIPPS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5136 RIVER RIDGE LN
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD TOWNSHIP
Mailing Address - State:OH
Mailing Address - Zip Code:45011-2245
Mailing Address - Country:US
Mailing Address - Phone:513-907-3547
Mailing Address - Fax:
Practice Address - Street 1:1168 N FRIEDA DR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-3316
Practice Address - Country:US
Practice Address - Phone:513-907-3547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-15
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA 18706-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily