Provider Demographics
NPI:1275072605
Name:TAMMY BIRBECK DO PLLC
Entity Type:Organization
Organization Name:TAMMY BIRBECK DO PLLC
Other - Org Name:GULF WOMEN'S CENTER FOR HEALTH & SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BIRBECK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-681-2042
Mailing Address - Street 1:2061 ENGLEWOOD RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:ENGLEWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:34223-1749
Mailing Address - Country:US
Mailing Address - Phone:941-408-3537
Mailing Address - Fax:
Practice Address - Street 1:900 PINE ST STE 111A
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:FL
Practice Address - Zip Code:34223-4457
Practice Address - Country:US
Practice Address - Phone:941-681-2042
Practice Address - Fax:941-208-5982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10000207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLJYT20OtherFLORIDA BLUE