Basic Information
| Provider Information | |||||||||
| NPI: | 1497019376 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOMB | ||||||||
| FirstName: | AMY | ||||||||
| MiddleName: | BAUM | ||||||||
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| Credential: | ANP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8585 PICARDY AVE | ||||||||
| Address2: | STE 410 | ||||||||
| City: | BATON ROUGE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 708093749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858760300 | ||||||||
| FaxNumber: | 9858720317 | ||||||||
| Practice Location | |||||||||
| Address1: | 6550 MAIN ST | ||||||||
| Address2: | STE. 1000 | ||||||||
| City: | ZACHARY | ||||||||
| State: | LA | ||||||||
| PostalCode: | 707914092 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2256541559 | ||||||||
| FaxNumber: | 2256546212 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2012 | ||||||||
| LastUpdateDate: | 03/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | AP06766 | LA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 2302248 | 05 | LA | MEDICAID |