Provider Demographics
NPI:1376851378
Name:GOULART, TAMMIE L (RN)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:L
Last Name:GOULART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:TAMMIE
Other - Middle Name:L
Other - Last Name:MURPHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4290 POLK AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92105-1524
Mailing Address - Country:US
Mailing Address - Phone:619-563-0507
Mailing Address - Fax:619-563-0015
Practice Address - Street 1:4290 POLK AVENUE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92105-1524
Practice Address - Country:US
Practice Address - Phone:619-563-0250
Practice Address - Fax:619-563-0293
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN782060163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse