Provider Demographics
NPI:1013396878
Name:FLOYD, TOMMIE JOANN (APN)
Entity Type:Individual
Prefix:MS
First Name:TOMMIE
Middle Name:JOANN
Last Name:FLOYD
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:TOMMIE
Other - Middle Name:JOANN
Other - Last Name:FLOYD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, APRN,FNP-C
Mailing Address - Street 1:845 SCENIC HWY
Mailing Address - Street 2:#100
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30046-7103
Mailing Address - Country:US
Mailing Address - Phone:770-962-6443
Mailing Address - Fax:770-964-8355
Practice Address - Street 1:6025 PROFESSIONAL PKWY STE 200
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30134-5610
Practice Address - Country:US
Practice Address - Phone:770-949-0555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-27
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN123475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1013396878Medicare NSC