Provider Demographics
NPI:1114707627
Name:PASSANTE, TAMMY L (FNP-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:PASSANTE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21248 S 158TH ST
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-9345
Mailing Address - Country:US
Mailing Address - Phone:480-710-9062
Mailing Address - Fax:
Practice Address - Street 1:4085 S GILBERT RD STE 8
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85249-2505
Practice Address - Country:US
Practice Address - Phone:480-710-9062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ298406363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily