Provider Demographics
NPI:1467872697
Name:O'FLYNN, TAMSYN CATHERINE (APRN)
Entity Type:Individual
Prefix:
First Name:TAMSYN
Middle Name:CATHERINE
Last Name:O'FLYNN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 MARINERS DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:KINGSLAND
Mailing Address - State:GA
Mailing Address - Zip Code:31548
Mailing Address - Country:US
Mailing Address - Phone:912-510-0669
Mailing Address - Fax:912-510-0754
Practice Address - Street 1:100 MARINERS DR
Practice Address - Street 2:SUITE D
Practice Address - City:KINGSLAND
Practice Address - State:GA
Practice Address - Zip Code:31548
Practice Address - Country:US
Practice Address - Phone:912-510-0669
Practice Address - Fax:912-510-0754
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-28
Last Update Date:2018-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN238103363LP0808X, 363L00000X
VA0024171215363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003148940DMedicaid