Provider Demographics
NPI:1689791451
Name:COLEMAN, TAMMY RENA
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:RENA
Last Name:COLEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 WINNERS CIRCLE NORTH #457
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1108
Mailing Address - Country:US
Mailing Address - Phone:419-524-7269
Mailing Address - Fax:
Practice Address - Street 1:1348 WINNERS CIRCLE NORTH #457
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44906-1108
Practice Address - Country:US
Practice Address - Phone:419-524-7269
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-090988164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse