Individual
TAMMY HOLFORTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1911 E REZANOF DR, KODIAK, AK 99615-6602
(907) 481-2484
Mailing address
1911 E REZANOF DR, KODIAK, AK 99615-6602
(907) 481-2484
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
2003
AK
363A00000X
Physician Assistant
PA17040
CA
Other
Enumeration date
02/27/2006
Last updated
01/08/2009
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