Provider Demographics
NPI:1811768567
Name:MAGARAGGIA, TAMMY JEAN
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:MAGARAGGIA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 BARAGA AVE
Mailing Address - Street 2:
Mailing Address - City:LANSE
Mailing Address - State:MI
Mailing Address - Zip Code:49946-1465
Mailing Address - Country:US
Mailing Address - Phone:906-482-7382
Mailing Address - Fax:
Practice Address - Street 1:540 DEPOT ST
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-2031
Practice Address - Country:US
Practice Address - Phone:906-482-7382
Practice Address - Fax:906-524-6144
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-11
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker