Provider Demographics
NPI:1821067919
Name:JANSEN, TAMMY KAY (CRNA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:KAY
Last Name:JANSEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4031 LOCHMOOR DR
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32506-7813
Mailing Address - Country:US
Mailing Address - Phone:619-632-8183
Mailing Address - Fax:
Practice Address - Street 1:1613 S. MCKENZIE DRIVE
Practice Address - Street 2:
Practice Address - City:FOLEY
Practice Address - State:AL
Practice Address - Zip Code:36535
Practice Address - Country:US
Practice Address - Phone:619-632-8183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARN 638091367500000X
AL1-133734367500000X
FL9321247367500000X
NM01153367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered