Provider Demographics
NPI:1851560858
Name:HYDE, TAMMIE (CRNA, APRN)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:
Last Name:HYDE
Suffix:
Gender:F
Credentials:CRNA, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 53RD ST E
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-2140
Mailing Address - Country:US
Mailing Address - Phone:727-599-1092
Mailing Address - Fax:
Practice Address - Street 1:1886 59TH ST W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34209-4630
Practice Address - Country:US
Practice Address - Phone:941-794-1980
Practice Address - Fax:941-794-1980
Is Sole Proprietor?:No
Enumeration Date:2008-02-22
Last Update Date:2022-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9207988363LA2100X, 363LG0600X
FLAPRN9207988367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC47792Medicare UPIN
FL001366400Medicaid