Provider Demographics
NPI:1801341433
Name:FLAHERTY, TAMMY (CNA)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:FLAHERTY
Suffix:
Gender:F
Credentials:CNA
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 298
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-0298
Mailing Address - Country:US
Mailing Address - Phone:205-534-0847
Mailing Address - Fax:877-778-7117
Practice Address - Street 1:4301 RIDGEMONT AVE
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35473-1623
Practice Address - Country:US
Practice Address - Phone:205-534-0847
Practice Address - Fax:877-778-7117
Is Sole Proprietor?:No
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27130E374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide