Provider Demographics
NPI:1467740878
Name:HISER, TAMI JEAN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:JEAN
Last Name:HISER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S MADISON ST
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-2321
Mailing Address - Country:US
Mailing Address - Phone:231-392-8400
Mailing Address - Fax:231-392-8467
Practice Address - Street 1:217 S MADISON ST
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-2321
Practice Address - Country:US
Practice Address - Phone:231-392-8400
Practice Address - Fax:231-392-8467
Is Sole Proprietor?:No
Enumeration Date:2011-07-19
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.12443-NP363LF0000X
MI4704305788363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0051852Medicaid
MI1467740878Medicaid
MI1467740878Medicaid
OH0051852Medicaid