Provider Demographics
NPI:1497070585
Name:JERNIGAN, TAMMY LEANNE RAY (ARNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LEANNE RAY
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 BAYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-5008
Mailing Address - Country:US
Mailing Address - Phone:850-512-8816
Mailing Address - Fax:
Practice Address - Street 1:4501 N DAVIS HWY STE C
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2724
Practice Address - Country:US
Practice Address - Phone:850-416-4960
Practice Address - Fax:850-416-4961
Is Sole Proprietor?:No
Enumeration Date:2010-03-31
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1563722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0026279-00Medicaid