Individual
TAMMI M SHORT
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-C
Contact information
Practice address
3535 N FOURTH ST STE 400, LONGVIEW, TX 75605-0038
(903) 757-3881
(903) 757-5948
Mailing address
3535 N FOURTH ST STE 400, LONGVIEW, TX 75605-0038
(903) 757-3881
(903) 757-5948
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
608154
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
157033504
MEDICAID INDIVIDUAL TPI
TX
01
—
302333501
MEDICAID GROUP TPI
TX
01
—
TXB145668
MEDICARE GROUP PTAN
TX
Enumeration date
03/09/2006
Last updated
03/04/2022
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