Provider Demographics
NPI:1912619396
Name:ROGERS, TAMMY (FNP-BC)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:ROGERS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:259 COVENANT DR NE
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37323-4443
Mailing Address - Country:US
Mailing Address - Phone:304-964-3951
Mailing Address - Fax:
Practice Address - Street 1:200 W MARTIN LUTHER KING BLVD STE 1000
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37402-2571
Practice Address - Country:US
Practice Address - Phone:423-269-2255
Practice Address - Fax:888-698-8617
Is Sole Proprietor?:No
Enumeration Date:2022-12-19
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11023440363LF0000X
GAGAA-NP001451363LF0000X
TN33988363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily