Provider Demographics
NPI:1245408749
Name:DIPPENWORTH, TAMMY LEE (LIC AP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LEE
Last Name:DIPPENWORTH
Suffix:
Gender:F
Credentials:LIC AP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3722 S CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-7608
Mailing Address - Country:US
Mailing Address - Phone:321-303-5946
Mailing Address - Fax:
Practice Address - Street 1:3722 S CONWAY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-7608
Practice Address - Country:US
Practice Address - Phone:321-303-5946
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP 2518171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist