Provider Demographics
NPI:1447515515
Name:MOORE, TAMMIE LYNN (NP)
Entity type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:LYNN
Last Name:MOORE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:TAMMIE
Other - Middle Name:LYNN
Other - Last Name:DAVIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15 EASTWIND CT
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19713-2825
Mailing Address - Country:US
Mailing Address - Phone:302-593-4595
Mailing Address - Fax:
Practice Address - Street 1:15 EASTWIND CT
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-2825
Practice Address - Country:US
Practice Address - Phone:302-593-4595
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-05
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000613363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily