Provider Demographics
NPI:1619691326
Name:SMOAK, TAMMIE MICHELLE (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:MICHELLE
Last Name:SMOAK
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TAMMIE
Other - Middle Name:KNIGHT
Other - Last Name:SMOAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1161 COOK RD
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29118-8204
Mailing Address - Country:US
Mailing Address - Phone:803-395-4615
Mailing Address - Fax:
Practice Address - Street 1:1161 COOK RD
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8204
Practice Address - Country:US
Practice Address - Phone:803-395-4615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27215363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily