Provider Demographics
NPI:1821800327
Name:HARRIS, TAMMY L
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:HARRIS
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 1:195 N SHORTRIDGE RD STE B
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-8909
Mailing Address - Country:US
Mailing Address - Phone:317-714-2638
Mailing Address - Fax:
Practice Address - Street 1:195 N SHORTRIDGE RD STE B
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-8909
Practice Address - Country:US
Practice Address - Phone:317-714-2638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-22
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN25-018569-1253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care