Provider Demographics
NPI:1124160478
Name:PURCELL, TAMMIE LYNN (CRNA)
Entity type:Individual
Prefix:
First Name:TAMMIE
Middle Name:LYNN
Last Name:PURCELL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TAMMIE
Other - Middle Name:L
Other - Last Name:TARWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-473-0181
Mailing Address - Fax:
Practice Address - Street 1:1314 E WALNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-2860
Practice Address - Country:US
Practice Address - Phone:812-254-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28087269A367H00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No367H00000XPhysician Assistants & Advanced Practice Nursing ProvidersAnesthesiologist Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1102467731OtherANTHEM PTAN
IN200859700Medicaid
IN163460063OtherMEDICARE PTAN
IN200859700Medicaid
IN183380190OtherMEDICARE PTAN