Provider Demographics
NPI:1669020616
Name:MARQUES, TAMMY ANNA
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANNA
Last Name:MARQUES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:ANNA
Other - Last Name:LACASSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:86 VILLAGE GRN N APT A
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:RI
Mailing Address - Zip Code:02915-3925
Mailing Address - Country:US
Mailing Address - Phone:401-996-4748
Mailing Address - Fax:
Practice Address - Street 1:125 BAY VIEW AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:RI
Practice Address - Zip Code:02915-4955
Practice Address - Country:US
Practice Address - Phone:401-996-4748
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-03
Last Update Date:2019-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI49819163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse