Provider Demographics
NPI:1275293151
Name:TAMISIEA, JEREMY W (MSN, APRN, NP-C, FNP)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:W
Last Name:TAMISIEA
Suffix:
Gender:M
Credentials:MSN, APRN, NP-C, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5228 S WOODSEDGE TRL
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-8452
Mailing Address - Country:US
Mailing Address - Phone:160-532-1804
Mailing Address - Fax:
Practice Address - Street 1:5228 S WOODSEDGE TRL
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-8452
Practice Address - Country:US
Practice Address - Phone:160-532-1804
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-20
Last Update Date:2022-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDCP002305363L00000X
SDR039978163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner