Provider Demographics
NPI:1841770377
Name:HASTINGS STINE, TAMMISE (FNP)
Entity Type:Individual
Prefix:
First Name:TAMMISE
Middle Name:
Last Name:HASTINGS STINE
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:PO BOX 14091
Mailing Address - Street 2:
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23518-0091
Mailing Address - Country:US
Mailing Address - Phone:757-729-5529
Mailing Address - Fax:
Practice Address - Street 1:160 KINGSLEY LN STE 100A
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23505-4635
Practice Address - Country:US
Practice Address - Phone:757-213-0101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-15
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176056363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily