Provider Demographics
NPI:1922251628
Name:JIVIDEN, TAMMY M (CRNA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:M
Last Name:JIVIDEN
Suffix:
Gender:F
Credentials:CRNA
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Mailing Address - Street 1:117 E KINGS HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:EDEN
Mailing Address - State:NC
Mailing Address - Zip Code:27288-5201
Mailing Address - Country:US
Mailing Address - Phone:336-623-9711
Mailing Address - Fax:336-623-9711
Practice Address - Street 1:MEDICAL CENTER BLVD
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27157-5201
Practice Address - Country:US
Practice Address - Phone:336-716-2255
Practice Address - Fax:336-716-3202
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2022-10-27
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Provider Licenses
StateLicense IDTaxonomies
VA0024168039367500000X
NC1232367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered