Provider Demographics
NPI:1457632721
Name:SMITH, TANDY M (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:TANDY
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 937
Mailing Address - Street 2:
Mailing Address - City:JESUP
Mailing Address - State:GA
Mailing Address - Zip Code:31598-0937
Mailing Address - Country:US
Mailing Address - Phone:912-427-6964
Mailing Address - Fax:912-427-0591
Practice Address - Street 1:330 PEACHTREE ST
Practice Address - Street 2:
Practice Address - City:JESUP
Practice Address - State:GA
Practice Address - Zip Code:31545-0244
Practice Address - Country:US
Practice Address - Phone:912-427-6964
Practice Address - Fax:912-427-0591
Is Sole Proprietor?:No
Enumeration Date:2011-08-31
Last Update Date:2011-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN085868363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily