Provider Demographics
NPI:1356853139
Name:JENKINS, TAMMIE R (MSN, FNP)
Entity Type:Individual
Prefix:MS
First Name:TAMMIE
Middle Name:R
Last Name:JENKINS
Suffix:
Gender:F
Credentials:MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 SHARMONT DR
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39402-1949
Mailing Address - Country:US
Mailing Address - Phone:601-323-0671
Mailing Address - Fax:
Practice Address - Street 1:3700 HARDY ST STE 10
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39402-1614
Practice Address - Country:US
Practice Address - Phone:601-602-2014
Practice Address - Fax:601-602-2015
Is Sole Proprietor?:No
Enumeration Date:2017-11-01
Last Update Date:2017-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS870300363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily