Provider Demographics
NPI:1326414137
Name:FAW SEVEREIDE, TAMMY (FNP-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:FAW SEVEREIDE
Suffix:
Gender:F
Credentials:FNP-C
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 33369
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28233-3369
Mailing Address - Country:US
Mailing Address - Phone:704-333-0741
Mailing Address - Fax:704-365-2073
Practice Address - Street 1:10512 PARK RD
Practice Address - Street 2:STE 101
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-8473
Practice Address - Country:US
Practice Address - Phone:803-329-3103
Practice Address - Fax:803-325-2232
Is Sole Proprietor?:No
Enumeration Date:2015-08-16
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20002RX363L00000X
SC20002363LF0000X
NC5008336363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily