Provider Demographics
NPI:1801100631
Name:PRITCHARD, TAMMY (DNP, NP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:PRITCHARD
Suffix:
Gender:F
Credentials:DNP, NP-C, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 W MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34981-4823
Mailing Address - Country:US
Mailing Address - Phone:772-468-5600
Mailing Address - Fax:772-468-5606
Practice Address - Street 1:4500 W MIDWAY RD
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34981-4823
Practice Address - Country:US
Practice Address - Phone:772-468-5600
Practice Address - Fax:772-468-5606
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-04
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9198840363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily