Provider Demographics
NPI:1205891785
Name:HALEY, TAMMY MICHELLE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:MICHELLE
Last Name:HALEY
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 1:70 1/2 MECHANIC STREET
Mailing Address - Street 2:
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701
Mailing Address - Country:US
Mailing Address - Phone:814-368-6129
Mailing Address - Fax:814-368-6174
Practice Address - Street 1:70 1/2 MECHANIC STREET
Practice Address - Street 2:
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701
Practice Address - Country:US
Practice Address - Phone:814-368-6129
Practice Address - Fax:814-368-6174
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-19
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP007465363L00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA070655L55Medicare PIN
PA070655L55Medicare PIN
PA1991407OtherHIGHMARK
PAP91732Medicare UPIN
PAHA1439253OtherHIGHMARK