Provider Demographics
NPI:1679532212
Name:SHIMFESSEL, TAMMY GRIFFIN (CPNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:GRIFFIN
Last Name:SHIMFESSEL
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:DARLENE
Other - Last Name:GRIFFIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1471 JAG BRANCH BLVD UNIT 101
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-6963
Practice Address - Country:US
Practice Address - Phone:336-515-7420
Practice Address - Fax:336-515-7430
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0003-00103363L00000X
NC300103363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7005674Medicaid
NC2594690Medicare UPIN