Provider Demographics
NPI:1174604946
Name:GRAGG, TAMMY LEA (DNP, FNP-C, PMHNP)
Entity type:Individual
Prefix:DR
First Name:TAMMY
Middle Name:LEA
Last Name:GRAGG
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:LEA
Other - Last Name:SKINNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP, DNP
Mailing Address - Street 1:PNC
Mailing Address - Street 2:PO BOX 31001-0698
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91110-0698
Mailing Address - Country:US
Mailing Address - Phone:602-263-1200
Mailing Address - Fax:
Practice Address - Street 1:4212 NORTH 16TH ST
Practice Address - Street 2:PIMC
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85016-5319
Practice Address - Country:US
Practice Address - Phone:602-263-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX671878363LF0000X
NVAPRN001724363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health