Provider Demographics
NPI:1841955598
Name:BENJAMIN, TAMMARA S (CPNP-PC)
Entity type:Individual
Prefix:
First Name:TAMMARA
Middle Name:S
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3023 LAUREL COVE WAY
Mailing Address - Street 2:
Mailing Address - City:GURLEY
Mailing Address - State:AL
Mailing Address - Zip Code:35748
Mailing Address - Country:US
Mailing Address - Phone:256-323-7011
Mailing Address - Fax:
Practice Address - Street 1:156 CHURCH AVE
Practice Address - Street 2:
Practice Address - City:NEW HOPE
Practice Address - State:AL
Practice Address - Zip Code:35760-9508
Practice Address - Country:US
Practice Address - Phone:256-723-4673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-154412163WP0200X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0200XNursing Service ProvidersRegistered NursePediatrics
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics