Provider Demographics
NPI:1013798131
Name:TOMMASEO, TAMMY NIKITA (NP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:NIKITA
Last Name:TOMMASEO
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 1:2300 CULOTTA ST
Mailing Address - Street 2:
Mailing Address - City:CHALMETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70043-4714
Mailing Address - Country:US
Mailing Address - Phone:504-650-2664
Mailing Address - Fax:
Practice Address - Street 1:2300 CULOTTA ST
Practice Address - Street 2:
Practice Address - City:CHALMETTE
Practice Address - State:LA
Practice Address - Zip Code:70043-4714
Practice Address - Country:US
Practice Address - Phone:504-650-2664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA229657363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner