Provider Demographics
NPI:1346371663
Name:MEDLIN, TAMMY L (FNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:L
Last Name:MEDLIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:L
Other - Last Name:HOSTETLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1010 MEDICAL CENTER DR # 200
Mailing Address - Street 2:
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-3447
Mailing Address - Country:US
Mailing Address - Phone:843-645-8220
Mailing Address - Fax:843-645-8221
Practice Address - Street 1:75 BAYLOR DR STE 155
Practice Address - Street 2:
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-8965
Practice Address - Country:US
Practice Address - Phone:843-706-2523
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2019-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN112985363LF0000X
GARN112985NP363LF0000X
SC20432363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA112985OtherNP LICENSE
GA511I500096OtherMEDICARE
GA106275669BMedicaid