Provider Demographics
NPI:1720851785
Name:TAMNY, JOHNNIE MICHELLE (PA-C)
Entity Type:Individual
Prefix:
First Name:JOHNNIE
Middle Name:MICHELLE
Last Name:TAMNY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 E COLFAX AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-2239
Mailing Address - Country:US
Mailing Address - Phone:303-268-2144
Mailing Address - Fax:
Practice Address - Street 1:1201 E COLFAX AVE STE 202
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-2239
Practice Address - Country:US
Practice Address - Phone:303-268-2144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-01
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0008151363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant