Provider Demographics
NPI:1013251859
Name:AGUILAR, TAMMY VARDEMAN (RN, NNP-BC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:VARDEMAN
Last Name:AGUILAR
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Gender:F
Credentials:RN, NNP-BC
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Other - First Name:
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Mailing Address - Street 1:101 W PONCE DE LEON AVE
Mailing Address - Street 2:SUITE #242
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30030-2542
Mailing Address - Country:US
Mailing Address - Phone:404-778-7622
Mailing Address - Fax:404-778-7645
Practice Address - Street 1:101 W PONCE DE LEON AVE
Practice Address - Street 2:SUITE #242
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30030-2542
Practice Address - Country:US
Practice Address - Phone:404-778-7622
Practice Address - Fax:404-778-7645
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-17
Last Update Date:2012-11-17
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
GARN117954363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal