Provider Demographics
NPI:1174019095
Name:YU, TAMMY (NP-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:YU
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:TSI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:174 W LINCOLN AVE # 503
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-2901
Mailing Address - Country:US
Mailing Address - Phone:714-270-4319
Mailing Address - Fax:
Practice Address - Street 1:100 S RAYMOND AVE
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3166
Practice Address - Country:US
Practice Address - Phone:626-570-1606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-03
Last Update Date:2018-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF07180117363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF07180117OtherAANP