Provider Demographics
NPI:1114693322
Name:FISHER, TAMMY RENAE (RDH)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:RENAE
Last Name:FISHER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 MARRIOTT DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37214-5048
Mailing Address - Country:US
Mailing Address - Phone:629-802-3226
Mailing Address - Fax:
Practice Address - Street 1:616 MARRIOTT DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-5048
Practice Address - Country:US
Practice Address - Phone:629-802-3226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7449124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist