Provider Demographics
NPI:1932106044
Name:COLEGROVE, TAMMY KAY (ARNP)
Entity Type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:KAY
Last Name:COLEGROVE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1215 PLEASANT ST
Mailing Address - Street 2:SUITE 506
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50309-1416
Mailing Address - Country:US
Mailing Address - Phone:515-241-4044
Mailing Address - Fax:515-241-4142
Practice Address - Street 1:1215 PLEASANT ST
Practice Address - Street 2:SUITE 506
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50309-1416
Practice Address - Country:US
Practice Address - Phone:515-214-4044
Practice Address - Fax:515-241-4299
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2012-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IAA107489363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA719260381Medicare PIN
IAI9318Medicare PIN
IAP73462Medicare UPIN