Provider Demographics
NPI:1669601670
Name:BRODIE, TAMMIE F (ANP-BC)
Entity type:Individual
Prefix:MS
First Name:TAMMIE
Middle Name:F
Last Name:BRODIE
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 401
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07095-0401
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:420 LEXINGTON AVE
Practice Address - Street 2:SUITE 1644
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10170-0002
Practice Address - Country:US
Practice Address - Phone:212-861-3313
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-11
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY304968363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health