Provider Demographics
NPI:1720689920
Name:PROHOFSKY, TAMMY LYNN (APRN, CNP)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:LYNN
Last Name:PROHOFSKY
Suffix:
Gender:F
Credentials:APRN, CNP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:
Other - Last Name:PERTTULA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, CNP
Mailing Address - Street 1:12490 FAIRBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:LONSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55046-4475
Mailing Address - Country:US
Mailing Address - Phone:763-257-9280
Mailing Address - Fax:
Practice Address - Street 1:11000 OPTUM CIR
Practice Address - Street 2:
Practice Address - City:EDEN PRAIRIE
Practice Address - State:MN
Practice Address - Zip Code:55344-2503
Practice Address - Country:US
Practice Address - Phone:866-686-2504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-04
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7897363L00000X
MNR147035-4363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner