Provider Demographics
NPI:1568432847
Name:WIND, TAMMY L (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:L
Last Name:WIND
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:KOCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:2080 CHILD ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32214-5005
Mailing Address - Country:US
Mailing Address - Phone:904-542-7302
Mailing Address - Fax:904-542-7442
Practice Address - Street 1:2080 CHILD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32214-5005
Practice Address - Country:US
Practice Address - Phone:904-542-7302
Practice Address - Fax:904-542-7442
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9211529363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics