Provider Demographics
NPI:1386099034
Name:JENSEN, TAMI (MSN, RN, AGACNP)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:
Last Name:JENSEN
Suffix:
Gender:F
Credentials:MSN, RN, AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:37771 SCHOENHERR RD
Mailing Address - Street 2:#101
Mailing Address - City:STERLING HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48312-2302
Mailing Address - Country:US
Mailing Address - Phone:586-698-1200
Mailing Address - Fax:586-698-1210
Practice Address - Street 1:37771 SCHOENHERR RD
Practice Address - Street 2:#101
Practice Address - City:STERLING HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48312-2302
Practice Address - Country:US
Practice Address - Phone:586-698-1200
Practice Address - Fax:586-698-1210
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-02
Last Update Date:2017-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4704217391363LA2100X, 163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine