Provider Demographics
NPI:1972840908
Name:PATTILLO, TAMMY J (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:PATTILLO
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 LAVACA RIVER CT
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78410-5677
Mailing Address - Country:US
Mailing Address - Phone:361-548-0105
Mailing Address - Fax:
Practice Address - Street 1:7326 S STAPLES ST STE A
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78413-5509
Practice Address - Country:US
Practice Address - Phone:361-993-0188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX571896363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care