Provider Demographics
NPI:1972987824
Name:FRIZZELL, TAMMIE LYNN (NP)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:LYNN
Last Name:FRIZZELL
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3014 WESTLAKE DR
Mailing Address - Street 2:
Mailing Address - City:LAVACA
Mailing Address - State:AR
Mailing Address - Zip Code:72941-3450
Mailing Address - Country:US
Mailing Address - Phone:479-322-9083
Mailing Address - Fax:
Practice Address - Street 1:2 SAINT VINCENT CIR
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5423
Practice Address - Country:US
Practice Address - Phone:501-552-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-09
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily