Provider Demographics
NPI:1144850637
Name:WOMACK, TAMMY (APRN, FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:
Last Name:WOMACK
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 E EATON ST
Mailing Address - Street 2:
Mailing Address - City:TRINIDAD
Mailing Address - State:TX
Mailing Address - Zip Code:75163-7165
Mailing Address - Country:US
Mailing Address - Phone:903-340-4148
Mailing Address - Fax:
Practice Address - Street 1:406 E EATON ST
Practice Address - Street 2:
Practice Address - City:TRINIDAD
Practice Address - State:TX
Practice Address - Zip Code:75163-7165
Practice Address - Country:US
Practice Address - Phone:903-340-4148
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-23
Last Update Date:2020-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP144607363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily