Provider Demographics
NPI:1659923076
Name:OLIVER, TAMMIE DIANNE (FNP)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:DIANNE
Last Name:OLIVER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1085 PLAZA AVE
Mailing Address - Street 2:
Mailing Address - City:EASTMAN
Mailing Address - State:GA
Mailing Address - Zip Code:31023-9102
Mailing Address - Country:US
Mailing Address - Phone:478-559-1386
Mailing Address - Fax:478-559-1388
Practice Address - Street 1:1085 PLAZA AVE
Practice Address - Street 2:
Practice Address - City:EASTMAN
Practice Address - State:GA
Practice Address - Zip Code:31023-9102
Practice Address - Country:US
Practice Address - Phone:478-559-1386
Practice Address - Fax:478-559-1388
Is Sole Proprietor?:No
Enumeration Date:2019-07-16
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN227422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily