Individual
TAMMY LYNN MICCO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
N.P.
Contact information
Practice address
4650 HILLS AND DALES RD NW, CANTON, OH 44708
(330) 649-9400
(330) 649-8059
Mailing address
4650 HILLS AND DALES RD NW, CANTON, OH 44708
(330) 649-9400
(330) 649-8059
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
16567
OH
363L00000X
Nurse Practitioner
Primary
NP16567
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16567
LICENSE NUMBER
OH
Enumeration date
10/07/2014
Last updated
10/14/2019
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