Provider Demographics
NPI:1942773908
Name:DAVIDSON, TAMMY JEAN (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:JEAN
Last Name:DAVIDSON
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1077 SAINT CLAIRS CREEK RD
Mailing Address - Street 2:
Mailing Address - City:CHILHOWIE
Mailing Address - State:VA
Mailing Address - Zip Code:24319-5893
Mailing Address - Country:US
Mailing Address - Phone:276-780-1192
Mailing Address - Fax:
Practice Address - Street 1:1077 SAINT CLAIRS CREEK RD
Practice Address - Street 2:
Practice Address - City:CHILHOWIE
Practice Address - State:VA
Practice Address - Zip Code:24319-5893
Practice Address - Country:US
Practice Address - Phone:276-780-1192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-02
Last Update Date:2019-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024176649363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health