Provider Demographics
NPI:1265489447
Name:PRESCOTT, TAMY (ARNP)
Entity Type:Individual
Prefix:
First Name:TAMY
Middle Name:
Last Name:PRESCOTT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 FOUNDRY ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03301-5421
Mailing Address - Country:US
Mailing Address - Phone:603-228-0071
Mailing Address - Fax:603-228-7014
Practice Address - Street 1:250 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-7539
Practice Address - Country:US
Practice Address - Phone:603-227-7140
Practice Address - Fax:603-227-7187
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH0146052303363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHS57106Medicare UPIN