Provider Demographics
NPI:1437425261
Name:WEIS, TAMMY JEAN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:JEAN
Last Name:WEIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:TAMMY
Other - Middle Name:JEAN
Other - Last Name:YANAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:100 HOSPITAL AVE
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-1440
Mailing Address - Country:US
Mailing Address - Phone:814-781-6758
Mailing Address - Fax:814-781-3317
Practice Address - Street 1:761 JOHNSONBURG RD STE 120
Practice Address - Street 2:
Practice Address - City:SAINT MARYS
Practice Address - State:PA
Practice Address - Zip Code:15857-3480
Practice Address - Country:US
Practice Address - Phone:814-788-8577
Practice Address - Fax:814-788-8541
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA363AM0700X
PA20000089782255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer