Provider Demographics
NPI:1134309297
Name:TODD, TAMMY (CRNP)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:
Last Name:TODD
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7877 TUSCANY DR
Mailing Address - Street 2:
Mailing Address - City:POLAND
Mailing Address - State:OH
Mailing Address - Zip Code:44514-5331
Mailing Address - Country:US
Mailing Address - Phone:717-873-1125
Mailing Address - Fax:
Practice Address - Street 1:7230 MARKET ST
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-4513
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:000-000-0000
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2020-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007001B363LF0000X
OHNP13409363LF0000X
OHNP-13409363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA049599XRNMedicare PIN
PA049599XRUMedicare PIN
PAP36116Medicare PIN