Provider Demographics
NPI:1720837826
Name:GILLES, TAMI (FNP)
Entity type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:
Last Name:GILLES
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MISS
Other - First Name:TAMI
Other - Middle Name:
Other - Last Name:OTTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:E8689 80TH AVE
Mailing Address - Street 2:
Mailing Address - City:MONDOVI
Mailing Address - State:WI
Mailing Address - Zip Code:54755-8796
Mailing Address - Country:US
Mailing Address - Phone:715-563-8393
Mailing Address - Fax:
Practice Address - Street 1:2522 GOLF RD STE 2
Practice Address - Street 2:
Practice Address - City:EAU CLAIRE
Practice Address - State:WI
Practice Address - Zip Code:54701-6033
Practice Address - Country:US
Practice Address - Phone:715-563-8393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI15346363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily