Provider Demographics
NPI:1306232780
Name:BAERGEN-WHITE, TAMMY LYNN (RN)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:BAERGEN-WHITE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1794 PALISADES DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6330
Mailing Address - Country:US
Mailing Address - Phone:817-925-9416
Mailing Address - Fax:
Practice Address - Street 1:1794 PALISADES DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-6330
Practice Address - Country:US
Practice Address - Phone:817-925-9416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-12
Last Update Date:2015-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9313985163WA2000X
TX604719163WA2000X
AL1-1497171163WA2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA2000XNursing Service ProvidersRegistered NurseAdministrator