Provider Demographics
NPI:1114687829
Name:TEDSEN, TAMMY MICHAELA (APRN, AG-ACNP)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:MICHAELA
Last Name:TEDSEN
Suffix:
Gender:F
Credentials:APRN, AG-ACNP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:MICHAELA
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 100265
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0265
Mailing Address - Country:US
Mailing Address - Phone:352-273-9000
Mailing Address - Fax:352-392-8413
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0816
Practice Address - Country:US
Practice Address - Phone:352-273-9000
Practice Address - Fax:352-392-8413
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182778363LA2100X
FLAPRN11014363363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care