Provider Demographics
NPI:1407058043
Name:ELLINGER, TAMMY L (RN, FNP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:ELLINGER
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 PARRY ST
Mailing Address - Street 2:
Mailing Address - City:ROME
Mailing Address - State:NY
Mailing Address - Zip Code:13440-4343
Mailing Address - Country:US
Mailing Address - Phone:315-337-8382
Mailing Address - Fax:315-281-0080
Practice Address - Street 1:6075 JUDD RD
Practice Address - Street 2:
Practice Address - City:ORISKANY
Practice Address - State:NY
Practice Address - Zip Code:13424-4218
Practice Address - Country:US
Practice Address - Phone:315-425-5390
Practice Address - Fax:315-426-3908
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2024-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY477645-1374T00000X
NYF350658-01207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No374T00000XNursing Service Related ProvidersReligious Nonmedical Nursing Personnel