Provider Demographics
NPI:1023066057
Name:FERGUSON, TAMMI L (FNP)
Entity type:Individual
Prefix:MRS
First Name:TAMMI
Middle Name:L
Last Name:FERGUSON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:116 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:TN
Mailing Address - Zip Code:38340-2231
Mailing Address - Country:US
Mailing Address - Phone:731-989-0001
Mailing Address - Fax:731-989-5151
Practice Address - Street 1:1700 W MARKET ST
Practice Address - Street 2:SUITE J
Practice Address - City:BOLIVAR
Practice Address - State:TN
Practice Address - Zip Code:38008-1653
Practice Address - Country:US
Practice Address - Phone:731-652-5772
Practice Address - Fax:731-658-1981
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN6811363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ06130Medicare UPIN