Provider Demographics
NPI:1760880124
Name:HANSEN, TAMMY
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:HANSEN
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 1:99198 OVERSEAS HWY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-2437
Mailing Address - Country:US
Mailing Address - Phone:305-481-5292
Mailing Address - Fax:305-451-8019
Practice Address - Street 1:99198 OVERSEAS HWY
Practice Address - Street 2:SUITE 3
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-2437
Practice Address - Country:US
Practice Address - Phone:305-481-5292
Practice Address - Fax:305-451-8019
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-16
Last Update Date:2014-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst