Provider Demographics
NPI:1093476533
Name:PARKS, TAMMY ANN
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANN
Last Name:PARKS
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 1:2380 E NICHOLS PL
Mailing Address - Street 2:
Mailing Address - City:CENTENNIAL
Mailing Address - State:CO
Mailing Address - Zip Code:80122-3201
Mailing Address - Country:US
Mailing Address - Phone:719-649-2773
Mailing Address - Fax:
Practice Address - Street 1:2380 E NICHOLS PL
Practice Address - Street 2:
Practice Address - City:CENTENNIAL
Practice Address - State:CO
Practice Address - Zip Code:80122-3201
Practice Address - Country:US
Practice Address - Phone:719-649-2773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-06
Last Update Date:2022-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider