Provider Demographics
NPI:1912044942
Name:POWELL, TAMMY E (CPNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:E
Last Name:POWELL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 W 132ND ST APT 1
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10037-3304
Mailing Address - Country:US
Mailing Address - Phone:212-491-6787
Mailing Address - Fax:
Practice Address - Street 1:135TH STREET AT CONVENT AVE
Practice Address - Street 2:A. PHILIP RANDOLPH HS-HEALTH CLINIC
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10031
Practice Address - Country:US
Practice Address - Phone:212-862-2203
Practice Address - Fax:212-862-2774
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380803-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics