Provider Demographics
NPI:1720154842
Name:HARGETT, TAMMY J (NP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:J
Last Name:HARGETT
Suffix:
Gender:F
Credentials:NP
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 3868
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47737-3868
Mailing Address - Country:US
Mailing Address - Phone:812-426-9565
Mailing Address - Fax:812-426-9572
Practice Address - Street 1:8600 N KENTUCKY AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-6302
Practice Address - Country:US
Practice Address - Phone:812-426-9565
Practice Address - Fax:812-426-9572
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71000735A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN78007036OtherKY MEDICAID
IN000000282096OtherANTHEM
IN200347790Medicaid
IN78007036OtherKY MEDICAID
IN000000282096OtherANTHEM
IN257900OOOOMedicare PIN
IN200347790Medicaid