Provider Demographics
NPI:1154518348
Name:SMART, TAMMY LYNN (RN)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:LYNN
Last Name:SMART
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10661 E 300 S
Mailing Address - Street 2:
Mailing Address - City:LAOTTO
Mailing Address - State:IN
Mailing Address - Zip Code:46763-9758
Mailing Address - Country:US
Mailing Address - Phone:260-316-1038
Mailing Address - Fax:
Practice Address - Street 1:528 N GRANDSTAFF DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:IN
Practice Address - Zip Code:46706-1660
Practice Address - Country:US
Practice Address - Phone:260-927-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-02
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28165817A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse