Provider Demographics
NPI:1548966575
Name:OLD DOMINION UNIVERSITY
Entity type:Organization
Organization Name:OLD DOMINION UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF ODU COMMUNITY CARE
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:
Authorized Official - Last Name:SPEERHAS
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, FNP-C, CEN
Authorized Official - Phone:757-683-4390
Mailing Address - Street 1:1881 UNIVERSITY DRIVE
Mailing Address - Street 2:SCHOOL OF NURSING
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453
Mailing Address - Country:US
Mailing Address - Phone:757-683-4390
Mailing Address - Fax:
Practice Address - Street 1:1881 UNIVERSITY DRIVE
Practice Address - Street 2:SCHOOL OF NURSING
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453
Practice Address - Country:US
Practice Address - Phone:757-683-4390
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OLD DOMINION UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-01
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty