Provider Demographics
NPI:1174596209
Name:TAMMINGA, TAOTAFA S (APRN)
Entity type:Individual
Prefix:
First Name:TAOTAFA
Middle Name:S
Last Name:TAMMINGA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 PARK ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-1742
Mailing Address - Country:US
Mailing Address - Phone:270-781-3910
Mailing Address - Fax:270-842-7177
Practice Address - Street 1:2724 NASHVILLE RD
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101
Practice Address - Country:US
Practice Address - Phone:270-781-3910
Practice Address - Fax:270-842-7177
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2018-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003634363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78007796Medicaid
KY50026658OtherRAILROAD MEDICARE
KY7800779600Medicaid
KY7800779600Medicaid
KY1188705Medicare ID - Type Unspecified