Provider Demographics
NPI:1598095143
Name:VERMEULEN, TAMMY DIANE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:DIANE
Last Name:VERMEULEN
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 S WESTERN AVE STE 4005
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73109-3436
Mailing Address - Country:US
Mailing Address - Phone:405-644-5040
Mailing Address - Fax:405-644-5039
Practice Address - Street 1:4221 S WESTERN AVE STE 4005
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-3436
Practice Address - Country:US
Practice Address - Phone:405-644-5040
Practice Address - Fax:405-644-5039
Is Sole Proprietor?:No
Enumeration Date:2010-01-04
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK77115363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily