Provider Demographics
NPI:1558400119
Name:HAGOOD, TAMMY REGINA
Entity Type:Individual
Prefix:MRS
First Name:TAMMY
Middle Name:REGINA
Last Name:HAGOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:719 HIGHWAY 70 N
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37857-4005
Mailing Address - Country:US
Mailing Address - Phone:423-272-0637
Mailing Address - Fax:
Practice Address - Street 1:201 PARK BLVD
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-2919
Practice Address - Country:US
Practice Address - Phone:423-272-7641
Practice Address - Fax:423-921-8073
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPN0000030883164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse