Provider Demographics
NPI:1518628163
Name:DOERHOFF, TAMMY (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:
Last Name:DOERHOFF
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 OLD FARM RD E
Mailing Address - Street 2:
Mailing Address - City:MEXICO
Mailing Address - State:MO
Mailing Address - Zip Code:65265-4200
Mailing Address - Country:US
Mailing Address - Phone:573-581-2455
Mailing Address - Fax:573-581-2702
Practice Address - Street 1:1051 OLD FARM RD E
Practice Address - Street 2:
Practice Address - City:MEXICO
Practice Address - State:MO
Practice Address - Zip Code:65265-4200
Practice Address - Country:US
Practice Address - Phone:573-581-2455
Practice Address - Fax:573-581-2702
Is Sole Proprietor?:No
Enumeration Date:2022-01-05
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021051163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty