Provider Demographics
NPI:1134557093
Name:JORGENSON, TAMI LYNN (RN)
Entity type:Individual
Prefix:
First Name:TAMI
Middle Name:LYNN
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O.BOX 388
Mailing Address - Street 2:5 MAIN ST
Mailing Address - City:LUCKEY
Mailing Address - State:OH
Mailing Address - Zip Code:43443
Mailing Address - Country:US
Mailing Address - Phone:419-343-5841
Mailing Address - Fax:
Practice Address - Street 1:5214 MIDDLETON PIKE
Practice Address - Street 2:APT# D
Practice Address - City:LUCKEY
Practice Address - State:OH
Practice Address - Zip Code:43443-9701
Practice Address - Country:US
Practice Address - Phone:419-343-5841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-30
Last Update Date:2013-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN348553163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse