Provider Demographics
NPI:1033111505
Name:STAHL, TAMMIE ANN (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:ANN
Last Name:STAHL
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 MENDENHALL ST
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-5226
Mailing Address - Country:US
Mailing Address - Phone:184-382-1867
Mailing Address - Fax:184-340-2183
Practice Address - Street 1:2095 HENRY TECKLENBURG DR
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29414-5733
Practice Address - Country:US
Practice Address - Phone:843-402-1436
Practice Address - Fax:843-402-1833
Is Sole Proprietor?:No
Enumeration Date:2005-08-13
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCAPN1020367500000X
NC4220367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCAN0672Medicaid
SCAN0672Medicaid