Provider Demographics
NPI:1447622014
Name:JUDY, TAMI LYNNE (CRNP)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:LYNNE
Last Name:JUDY
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:TAMI
Other - Middle Name:LYNNE
Other - Last Name:TUNSTALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:126 E CHURCH ST STE 2300
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2272
Mailing Address - Country:US
Mailing Address - Phone:814-444-6260
Mailing Address - Fax:814-443-1249
Practice Address - Street 1:126 E CHURCH ST STE 2300
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2272
Practice Address - Country:US
Practice Address - Phone:814-444-6260
Practice Address - Fax:814-443-1249
Is Sole Proprietor?:No
Enumeration Date:2015-10-22
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP015458363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA455083Medicare PIN