Provider Demographics
NPI:1679572374
Name:WALZ, TAMMIE ELIZABETH (NP)
Entity Type:Individual
Prefix:MS
First Name:TAMMIE
Middle Name:ELIZABETH
Last Name:WALZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MS
Other - First Name:TAMMIE
Other - Middle Name:ELIZABETH
Other - Last Name:WAY WALZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:1326 EISENHOWER DR
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3928
Mailing Address - Country:US
Mailing Address - Phone:912-691-4100
Mailing Address - Fax:912-691-4289
Practice Address - Street 1:1326 EISENHOWER DR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3928
Practice Address - Country:US
Practice Address - Phone:912-691-4100
Practice Address - Fax:912-691-4289
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN077768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0876Medicaid
GA50BBDFDMedicare ID - Type Unspecified
SCNP0876Medicaid