Provider Demographics
NPI:1295282978
Name:TAMMY SERVICES
Entity type:Organization
Organization Name:TAMMY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:TAMARA
Authorized Official - Middle Name:
Authorized Official - Last Name:JEAN PIERRE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:863-212-4777
Mailing Address - Street 1:3070 CONGRESS PARK DR APT 722
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33461-5263
Mailing Address - Country:US
Mailing Address - Phone:863-212-4777
Mailing Address - Fax:863-453-3201
Practice Address - Street 1:3070 CONGRESS PARK DR APT 722
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33461-5263
Practice Address - Country:US
Practice Address - Phone:561-255-6675
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAMARA JEAN PIERRE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20866302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization