Provider Demographics
NPI:1063534709
Name:DIEFFENBACH, TAMMY ANN (LM)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:ANN
Last Name:DIEFFENBACH
Suffix:
Gender:F
Credentials:LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 SW FEDERAL HWY STE M
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-2925
Mailing Address - Country:US
Mailing Address - Phone:772-200-4277
Mailing Address - Fax:772-919-4280
Practice Address - Street 1:611 SW FEDERAL HWY STE M
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2925
Practice Address - Country:US
Practice Address - Phone:772-200-4277
Practice Address - Fax:772-919-4280
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2017-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW152176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife