Provider Demographics
NPI:1700637337
Name:GARNETT, TAMMY04101971 RENAE (RN)
Entity Type:Individual
Prefix:
First Name:TAMMY04101971
Middle Name:RENAE
Last Name:GARNETT
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 DAGGER LN
Mailing Address - Street 2:
Mailing Address - City:WYTHEVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:24382-6068
Mailing Address - Country:US
Mailing Address - Phone:276-620-6432
Mailing Address - Fax:276-383-8021
Practice Address - Street 1:176 DAGGER LN
Practice Address - Street 2:
Practice Address - City:WYTHEVILLE
Practice Address - State:VA
Practice Address - Zip Code:24382-6068
Practice Address - Country:US
Practice Address - Phone:276-620-6432
Practice Address - Fax:276-383-8021
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-01
Last Update Date:2024-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
253Z00000X, 385H00000X
VA3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Multi-Specialty
No253Z00000XAgenciesIn Home Supportive Care
No385H00000XRespite Care FacilityRespite Care