Provider Demographics
NPI:1558369314
Name:HEDRICK, TAMMY THERESA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:THERESA
Last Name:HEDRICK
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N LAWNWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4835
Mailing Address - Country:US
Mailing Address - Phone:772-429-3108
Mailing Address - Fax:772-465-0163
Practice Address - Street 1:1401 N LAWNWOOD CIR
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4835
Practice Address - Country:US
Practice Address - Phone:772-429-3108
Practice Address - Fax:772-465-0163
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2835832363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271798100Medicaid
FLY0700WMedicare ID - Type Unspecified