Provider Demographics
NPI:1710099411
Name:THAYER, TAMMY (CRNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:THAYER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S MAIN ST
Mailing Address - Street 2:STE 150 - INTERNAL MEDICINE
Mailing Address - City:JAMESTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:14701-6627
Mailing Address - Country:US
Mailing Address - Phone:716-488-1877
Mailing Address - Fax:716-488-1986
Practice Address - Street 1:15 S MAIN ST
Practice Address - Street 2:STE 150 - INTERNAL MEDICINE
Practice Address - City:JAMESTOWN
Practice Address - State:NY
Practice Address - Zip Code:14701-6627
Practice Address - Country:US
Practice Address - Phone:716-488-1877
Practice Address - Fax:716-488-1986
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF303679-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYF303679OtherLICENSE
NYRB5784Medicare PIN
NYP00622721Medicare PIN
NYP00647777Medicare PIN
NYBA1089Medicare PIN