Provider Demographics
NPI:1770557084
Name:CAMIDGE, TAMMY SUE (FNP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:SUE
Last Name:CAMIDGE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7785 N STATE ST
Mailing Address - Street 2:
Mailing Address - City:LOWVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13367-1229
Mailing Address - Country:US
Mailing Address - Phone:315-376-5480
Mailing Address - Fax:315-376-5495
Practice Address - Street 1:7785 N STATE ST
Practice Address - Street 2:
Practice Address - City:LOWVILLE
Practice Address - State:NY
Practice Address - Zip Code:13367-1229
Practice Address - Country:US
Practice Address - Phone:315-376-5480
Practice Address - Fax:315-376-5495
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF331465363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01674611Medicaid
NYS76627Medicare UPIN
NYBB4402Medicare ID - Type Unspecified