Provider Demographics
NPI:1316401169
Name:GORE, TAMMIE WEST (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:WEST
Last Name:GORE
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HIGHWAY 96 S
Mailing Address - Street 2:
Mailing Address - City:SILSBEE
Mailing Address - State:TX
Mailing Address - Zip Code:77656-4803
Mailing Address - Country:US
Mailing Address - Phone:409-385-3118
Mailing Address - Fax:409-351-3686
Practice Address - Street 1:105 HIGHWAY 96 S
Practice Address - Street 2:
Practice Address - City:SILSBEE
Practice Address - State:TX
Practice Address - Zip Code:77656-4803
Practice Address - Country:US
Practice Address - Phone:409-385-3118
Practice Address - Fax:409-351-3686
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-25
Last Update Date:2024-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140315363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX661956OtherRN LICENSE NO.
TXAP140315OtherAPRN LICENSE NO.
TX29019OtherRX AUTH. NUMBER