Provider Demographics
NPI:1619660222
Name:WIGGINS, TAMMY (NP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:WIGGINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 OLD REYNOLDS ST
Mailing Address - Street 2:
Mailing Address - City:WAYCROSS
Mailing Address - State:GA
Mailing Address - Zip Code:31501-1036
Mailing Address - Country:US
Mailing Address - Phone:912-283-1359
Mailing Address - Fax:
Practice Address - Street 1:1720 OLD REYNOLDS ST
Practice Address - Street 2:
Practice Address - City:WAYCROSS
Practice Address - State:GA
Practice Address - Zip Code:31501-1036
Practice Address - Country:US
Practice Address - Phone:912-283-1359
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN212034363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily