Provider Demographics
NPI:1104906312
Name:PRITCHETT, TAMMY (GNP-C)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:PRITCHETT
Suffix:
Gender:F
Credentials:GNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 LYNN RD STE 120
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-8033
Mailing Address - Country:US
Mailing Address - Phone:805-497-3585
Mailing Address - Fax:805-497-1313
Practice Address - Street 1:2100 LYNN RD STE 120
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-8033
Practice Address - Country:US
Practice Address - Phone:805-497-3585
Practice Address - Fax:805-497-1313
Is Sole Proprietor?:No
Enumeration Date:2006-10-16
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA528545163W00000X
CA13506163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A440630OtherMEDICAL
CA00A440630OtherMEDICAL
CAB49433Medicare UPIN