Provider Demographics
NPI:1104533264
Name:ROSS, TAMMY DENISE
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:DENISE
Last Name:ROSS
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:PO BOX 985
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:VA
Mailing Address - Zip Code:22974-0985
Mailing Address - Country:US
Mailing Address - Phone:804-247-3109
Mailing Address - Fax:
Practice Address - Street 1:16580 JAMES MADISON HWY
Practice Address - Street 2:
Practice Address - City:PALMYRA
Practice Address - State:VA
Practice Address - Zip Code:22963
Practice Address - Country:US
Practice Address - Phone:804-247-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-28
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program