Provider Demographics
NPI:1891387767
Name:GATLIN, TAMMIA ANTOINETTE (LPN)
Entity Type:Individual
Prefix:
First Name:TAMMIA
Middle Name:ANTOINETTE
Last Name:GATLIN
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1922 GRASSY BANKS DR
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27610-6472
Mailing Address - Country:US
Mailing Address - Phone:984-201-4167
Mailing Address - Fax:
Practice Address - Street 1:1922 GRASSY BANKS DR
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27610-6472
Practice Address - Country:US
Practice Address - Phone:984-201-4167
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-10
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC88339164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse