Provider Demographics
NPI:1538137153
Name:SHORT, TAMMI M (FNP-C)
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:M
Last Name:SHORT
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 N FOURTH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75605-0038
Mailing Address - Country:US
Mailing Address - Phone:903-757-3881
Mailing Address - Fax:903-757-5948
Practice Address - Street 1:3535 N FOURTH ST STE 400
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75605-0038
Practice Address - Country:US
Practice Address - Phone:903-757-3881
Practice Address - Fax:903-757-5948
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX608154363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX302333501OtherMEDICAID GROUP TPI
TXTXB145668OtherMEDICARE GROUP PTAN
TX157033504OtherMEDICAID INDIVIDUAL TPI
TXTXB145668OtherMEDICARE GROUP PTAN
TXP79414Medicare UPIN