Provider Demographics
NPI:1346248192
Name:BARRETT, TAMMY RENEE (CRNA)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:RENEE
Last Name:BARRETT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:BARRETT
Other - Last Name:WIDICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:2630 77TH AVE SE
Mailing Address - Street 2:# 413
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-4053
Mailing Address - Country:US
Mailing Address - Phone:206-240-0589
Mailing Address - Fax:
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:SUITE 570
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-451-7335
Practice Address - Fax:425-451-1226
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2010-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2192222363L00000X
WAAP 60118439367500000X
OR200960025CRNA367500000X
FLARNP2192222367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL030313400Medicaid
FLG2668VMedicare PIN