Individual
TAMMY RENEE HEREDIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
905 EL CAMINO REAL, SIERRA VISTA, AZ 85635-5456
(520) 515-2996
Mailing address
905 EL CAMINO REAL, SIERRA VISTA, AZ 85635-5456
(520) 515-2996
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
257842
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163WS0200X
—
AZ
Enumeration date
07/30/2021
Last updated
07/30/2021
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