Provider Demographics
NPI:1457965154
Name:CARTER, TAMMY CHARLENE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:CHARLENE
Last Name:CARTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17493 US HIGHWAY 129
Mailing Address - Street 2:
Mailing Address - City:ALAPAHA
Mailing Address - State:GA
Mailing Address - Zip Code:31622-6850
Mailing Address - Country:US
Mailing Address - Phone:229-848-5073
Mailing Address - Fax:
Practice Address - Street 1:602 N HUTCHINSON AVE
Practice Address - Street 2:
Practice Address - City:ADEL
Practice Address - State:GA
Practice Address - Zip Code:31620-1900
Practice Address - Country:US
Practice Address - Phone:229-848-5073
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-01
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAF06202941363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily