Provider Demographics
NPI:1215927488
Name:DRERUP, TAMMY (OPAC, RT)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:DRERUP
Suffix:
Gender:F
Credentials:OPAC, RT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7510 ECHO PINES DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-3140
Mailing Address - Country:US
Mailing Address - Phone:281-989-7442
Mailing Address - Fax:
Practice Address - Street 1:7510 ECHO PINES DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-3140
Practice Address - Country:US
Practice Address - Phone:281-989-7442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AS0400X
TX982426163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical