Provider Demographics
NPI:1053205591
Name:TAMMARIELLO, ELIZABETH MARCELLE
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MARCELLE
Last Name:TAMMARIELLO
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MARCELLE
Other - Middle Name:TAMMARIELLO
Other - Last Name:DYAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5803 BLANCO RIVER PASS
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-2837
Mailing Address - Country:US
Mailing Address - Phone:337-371-0374
Mailing Address - Fax:
Practice Address - Street 1:5803 BLANCO RIVER PASS
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-2837
Practice Address - Country:US
Practice Address - Phone:337-371-0374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program