Provider Demographics
NPI:1093201071
Name:SHORTT, TAMMY STUCKEY (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:STUCKEY
Last Name:SHORTT
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 LEE ST
Mailing Address - Street 2:
Mailing Address - City:DARLINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29532-4817
Mailing Address - Country:US
Mailing Address - Phone:803-370-3420
Mailing Address - Fax:
Practice Address - Street 1:376 W PALMETTO ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:SC
Practice Address - Zip Code:29501-4418
Practice Address - Country:US
Practice Address - Phone:843-799-0642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-02
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21901363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily