Provider Demographics
NPI:1508816968
Name:TATE-GOBERT, TAMMY (ANP-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:TATE-GOBERT
Suffix:
Gender:F
Credentials:ANP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1395
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70602-1395
Mailing Address - Country:US
Mailing Address - Phone:337-494-2121
Mailing Address - Fax:337-494-2360
Practice Address - Street 1:1701 OAK PARK BLVD
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-8911
Practice Address - Country:US
Practice Address - Phone:337-494-2121
Practice Address - Fax:337-494-2360
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO4589363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAP00214394OtherRRMEDICARE
LA1594873Medicaid
LA4H411CT60Medicare ID - Type UnspecifiedLA099
LA1594873Medicaid
LA4H411CH88Medicare ID - Type UnspecifiedLA001