Provider Demographics
NPI:1649772153
Name:BIRCH, TAMMI S (RN BSN)
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:S
Last Name:BIRCH
Suffix:
Gender:F
Credentials:RN BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 MORNING DOVE RD
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:TX
Mailing Address - Zip Code:75163-2103
Mailing Address - Country:US
Mailing Address - Phone:972-365-4413
Mailing Address - Fax:
Practice Address - Street 1:224 MORNING DOVE RD
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:TX
Practice Address - Zip Code:75163-2103
Practice Address - Country:US
Practice Address - Phone:972-365-4413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX788882163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse