Basic Information
| Provider Information | |||||||||
| NPI: | 1215215819 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WOOD | ||||||||
| FirstName: | TAMMY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | M.S. PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1945 STATE ROUTE 33 | ||||||||
| Address2: | |||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077534859 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7324133626 | ||||||||
| FaxNumber: | 7327762344 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 CORLIES AVE | ||||||||
| Address2: | SUITE 12 | ||||||||
| City: | NEPTUNE | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077536102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7322637960 | ||||||||
| FaxNumber: | 7322637961 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/30/2011 | ||||||||
| LastUpdateDate: | 01/08/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | 25MP00317700 | NJ | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.