Provider Demographics
NPI:1679553804
Name:MCCOMAK, TAMMI KAY (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMMI
Middle Name:KAY
Last Name:MCCOMAK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:561 HANSEN CT
Mailing Address - Street 2:
Mailing Address - City:PATTERSON
Mailing Address - State:CA
Mailing Address - Zip Code:95363-9315
Mailing Address - Country:US
Mailing Address - Phone:209-892-5369
Mailing Address - Fax:
Practice Address - Street 1:530 W EATON AVE
Practice Address - Street 2:SUITE K
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3400
Practice Address - Country:US
Practice Address - Phone:209-835-4232
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15459363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily