Provider Demographics
NPI:1053309203
Name:TENACE, TAMMY (NP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:TENACE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5610 PERSIMMON ST
Mailing Address - Street 2:APT B
Mailing Address - City:SHAW A F B
Mailing Address - State:SC
Mailing Address - Zip Code:29152-1310
Mailing Address - Country:US
Mailing Address - Phone:803-499-1705
Mailing Address - Fax:
Practice Address - Street 1:431 MEADOWLARK ST
Practice Address - Street 2:
Practice Address - City:SHAW A F B
Practice Address - State:SC
Practice Address - Zip Code:29152-5019
Practice Address - Country:US
Practice Address - Phone:803-895-6580
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR097322363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health