Provider Demographics
NPI:1467695106
Name:ENDICOTT, TAMMY JOAN DONNA (FNP-BC, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:JOAN DONNA
Last Name:ENDICOTT
Suffix:
Gender:F
Credentials:FNP-BC, PMHNP-BC
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:FARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4360 MONTEBELLO DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7204
Mailing Address - Country:US
Mailing Address - Phone:719-388-1594
Mailing Address - Fax:
Practice Address - Street 1:4360 MONTEBELLO DR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-7204
Practice Address - Country:US
Practice Address - Phone:719-388-1594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-10
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COAPN.0005590-NP363LP0808X
CO5590363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health