Provider Demographics
NPI:1174084339
Name:PAYNE, TAMMIE (CRNP)
Entity type:Individual
Prefix:
First Name:TAMMIE
Middle Name:
Last Name:PAYNE
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 S BREEZEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BREEZEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:15533-8913
Mailing Address - Country:US
Mailing Address - Phone:814-977-0480
Mailing Address - Fax:
Practice Address - Street 1:300 N SPRING ST
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:PA
Practice Address - Zip Code:15537-1011
Practice Address - Country:US
Practice Address - Phone:814-652-5133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP020186363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily