Provider Demographics
NPI:1154087625
Name:GLEETON, TAMARA
Entity Type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:
Last Name:GLEETON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 EQ GLEETON
Mailing Address - Street 2:
Mailing Address - City:SARDIS
Mailing Address - State:MS
Mailing Address - Zip Code:38666-5683
Mailing Address - Country:US
Mailing Address - Phone:901-232-4614
Mailing Address - Fax:
Practice Address - Street 1:310 EQ GLEETON
Practice Address - Street 2:
Practice Address - City:SARDIS
Practice Address - State:MS
Practice Address - Zip Code:38666-5683
Practice Address - Country:US
Practice Address - Phone:901-232-4614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide