Provider Demographics
NPI:1760231781
Name:HAGGARD, TAMMI
Entity type:Individual
Prefix:
First Name:TAMMI
Middle Name:
Last Name:HAGGARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4413 MISTY BREEZE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89031-0251
Mailing Address - Country:US
Mailing Address - Phone:702-742-4994
Mailing Address - Fax:
Practice Address - Street 1:4413 MISTY BREEZE CIR
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89031-0251
Practice Address - Country:US
Practice Address - Phone:702-742-4994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-13
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty