Provider Demographics
NPI:1558747105
Name:LEYDIG, TAMMIE MARIE (CNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:MARIE
Last Name:LEYDIG
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 S APOPKA AVE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452-4803
Mailing Address - Country:US
Mailing Address - Phone:352-508-7310
Mailing Address - Fax:833-905-0111
Practice Address - Street 1:214 S APOPKA AVE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452-4803
Practice Address - Country:US
Practice Address - Phone:352-508-7310
Practice Address - Fax:833-905-0111
Is Sole Proprietor?:No
Enumeration Date:2015-08-06
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2768341163W00000X
FL9479374363LF0000X
OH17310363LF0000X
FLAPRN9479374363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL113458400Medicaid
OH3025372Medicaid
OH9376891Medicare PIN
OH9389631Medicare PIN
OHH072820Medicare PIN