Provider Demographics
NPI:1497019376
Name:TOMB, AMY BAUM (ANP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:BAUM
Last Name:TOMB
Suffix:
Gender:F
Credentials:ANP
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8585 PICARDY AVE
Mailing Address - Street 2:STE 410
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-3749
Mailing Address - Country:US
Mailing Address - Phone:985-876-0300
Mailing Address - Fax:985-872-0317
Practice Address - Street 1:6550 MAIN ST
Practice Address - Street 2:STE. 1000
Practice Address - City:ZACHARY
Practice Address - State:LA
Practice Address - Zip Code:70791-4092
Practice Address - Country:US
Practice Address - Phone:225-654-1559
Practice Address - Fax:225-654-6212
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2018-03-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LAAP06766363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2302248Medicaid
LA2302248Medicaid