Provider Demographics
NPI:1730997024
Name:TENNY, TAMMY JAMEESE
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:JAMEESE
Last Name:TENNY
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 1:565 KERN ST
Mailing Address - Street 2:
Mailing Address - City:SHAFTER
Mailing Address - State:CA
Mailing Address - Zip Code:93263-2133
Mailing Address - Country:US
Mailing Address - Phone:661-746-4937
Mailing Address - Fax:
Practice Address - Street 1:1100 BEAR MOUNTAIN BLVD
Practice Address - Street 2:
Practice Address - City:ARVIN
Practice Address - State:CA
Practice Address - Zip Code:93203-1345
Practice Address - Country:US
Practice Address - Phone:661-459-1020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-19
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95029508363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner