Provider Demographics
NPI:1356373039
Name:ONDREJKA, TAMMY LYNN
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LYNN
Last Name:ONDREJKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 TWELVE OAKS DR APT F5
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-6396
Mailing Address - Country:US
Mailing Address - Phone:904-614-1258
Mailing Address - Fax:
Practice Address - Street 1:2300 TWELVE OAKS DR
Practice Address - Street 2:F5
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32065-9021
Practice Address - Country:US
Practice Address - Phone:904-614-1258
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2018-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW60321041C0700X
TX652471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ0546OtherBLUE CROSS BLUE SHIELD
FLZ0546OtherBLUE CROSS BLUE SHIELD