Provider Demographics
NPI:1760751010
Name:CLEMMONS, TAMMY (CRNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:CLEMMONS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:325 CLOVERLEAF CIR
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-7043
Mailing Address - Country:US
Mailing Address - Phone:256-366-4343
Mailing Address - Fax:
Practice Address - Street 1:6920 MIRAMAR RD
Practice Address - Street 2:STE. 305
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2632
Practice Address - Country:US
Practice Address - Phone:858-935-7373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1082123363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health