Provider Demographics
NPI:1184125445
Name:LEE, TAMMY HOADLEY (APRN)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:HOADLEY
Last Name:LEE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 IVY CT
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-4123
Mailing Address - Country:US
Mailing Address - Phone:228-209-0072
Mailing Address - Fax:
Practice Address - Street 1:735 S WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36603-1301
Practice Address - Country:US
Practice Address - Phone:251-433-2642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-22
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902522363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL1-166819OtherBOARD OF NURSING
MS896464OtherBOARD OF NURSING
MS902522OtherBOARD OF NURSING