Provider Demographics
NPI:1629065784
Name:BRANT, TAMMY MARIE (CNM, NP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:MARIE
Last Name:BRANT
Suffix:
Gender:F
Credentials:CNM, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:HORSEHEADS
Mailing Address - State:NY
Mailing Address - Zip Code:14845-1704
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 FITCH ST
Practice Address - Street 2:SUITE 206
Practice Address - City:ELMIRA
Practice Address - State:NY
Practice Address - Zip Code:14905-1634
Practice Address - Country:US
Practice Address - Phone:607-732-1515
Practice Address - Fax:607-732-2234
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2011-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001118-1176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000162403OtherBCBS PROVIDER ID#
NY161568690OtherPOMCO PROVIDER ID#
NY1899697OtherGHI PPO PROVIDER ID#
NY161568690OtherUNITED HEALTHCARE ID#
NY000560818005OtherHEALTHNOW PROVIDER ID#
NY02473783Medicaid
NY7647523OtherAETNA PROVIDER ID#
PA1011553890001Medicaid
NY161568690OtherUNITED HEALTHCARE ID#
NY7647523OtherAETNA PROVIDER ID#