Provider Demographics
NPI:1780878736
Name:SARMIENTO, TAMMY (NP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:SARMIENTO
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 1:530 NE GLEN OAK AVE
Mailing Address - Street 2:4TH FLOOR NORTHBUILDING- PALLIATIVE CARE SERVICES
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61637-0001
Mailing Address - Country:US
Mailing Address - Phone:309-624-1818
Mailing Address - Fax:309-624-8820
Practice Address - Street 1:530 NE GLEN OAK AVE
Practice Address - Street 2:4TH FLOOR NORTHBUILDING- PALLIATIVE CARE SERVICES
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61637-0001
Practice Address - Country:US
Practice Address - Phone:309-624-1818
Practice Address - Fax:309-624-8820
Is Sole Proprietor?:No
Enumeration Date:2007-09-04
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL209-006726363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL809840OtherMEDICARE GROUP #
ILCA4079OtherRR MEDICARE GROUP PTAN
ILP00680131OtherRR MEDICARE MEMBER PTAN
ILP00680131OtherRR MEDICARE MEMBER PTAN