Provider Demographics
NPI:1114571999
Name:FLYNN, TAMMY M (APNP,PMHNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:M
Last Name:FLYNN
Suffix:
Gender:F
Credentials:APNP,PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E1634 PARK VIEW WAY
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-8462
Mailing Address - Country:US
Mailing Address - Phone:920-939-5526
Mailing Address - Fax:
Practice Address - Street 1:E1634 PARK VIEW WAY
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-8462
Practice Address - Country:US
Practice Address - Phone:920-939-5526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-30
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI9247-33363LP0808X
WI9247363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health