Provider Demographics
NPI:1992145403
Name:LOVE, TAMMY MARIA (FA, CST, AD01/)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:MARIA
Last Name:LOVE
Suffix:
Gender:F
Credentials:FA, CST, AD01/
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Mailing Address - Street 1:104 LIVE OAK ST
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-1316
Mailing Address - Country:US
Mailing Address - Phone:504-458-9351
Mailing Address - Fax:
Practice Address - Street 1:4200 HOUMA BLVD
Practice Address - Street 2:SURGERY DEPARTMENT 3RD FLOOR
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2970
Practice Address - Country:US
Practice Address - Phone:504-454-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical