Provider Demographics
NPI:1164742789
Name:LEDFORD, TAMARA (FNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:LEDFORD
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 547
Mailing Address - Street 2:
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-0547
Mailing Address - Country:US
Mailing Address - Phone:843-663-8000
Mailing Address - Fax:843-663-8109
Practice Address - Street 1:3236 HOLMESTOWN RD
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7495
Practice Address - Country:US
Practice Address - Phone:843-663-8063
Practice Address - Fax:843-663-8163
Is Sole Proprietor?:No
Enumeration Date:2010-06-05
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18095363LF0000X
TN15020363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily