Provider Demographics
NPI:1154034445
Name:MCBRIDE, TAMMY LYNN (MA)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:MCBRIDE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 MARSH HAWK LN UNIT 616
Mailing Address - Street 2:
Mailing Address - City:FLEMING ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32003-4315
Mailing Address - Country:US
Mailing Address - Phone:904-945-1635
Mailing Address - Fax:
Practice Address - Street 1:640 BREVARD AVE STE 104
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32922-7849
Practice Address - Country:US
Practice Address - Phone:321-433-1111
Practice Address - Fax:321-252-0425
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-02
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FLIMH24434101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty