Provider Demographics
NPI:1508405309
Name:TAMMY WAGSTAFF, DNP, APRN-CNP, PLLC
Entity Type:Organization
Organization Name:TAMMY WAGSTAFF, DNP, APRN-CNP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WAGSTAFF
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, APRN-CNP
Authorized Official - Phone:405-409-2897
Mailing Address - Street 1:16208 JULIET DR
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-9235
Mailing Address - Country:US
Mailing Address - Phone:405-409-2897
Mailing Address - Fax:
Practice Address - Street 1:5705 NW 132ND ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-4437
Practice Address - Country:US
Practice Address - Phone:405-409-2897
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-27
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty