MEDICARE: TAMMY SUE PAGE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	254674	SC
2	363LF0000X	Family Nurse Practitioner	29977	SC

General Provider Information

NPI Number	:	1093477820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY SUE PAGE

Provider Business Mailing Address
First Line	:	70 BASS LAKE DR
Second Line	:
City	:	RIDGELAND
State	:	SC
Zip	:	29936-6704
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	122 OKATIE CENTER BLVD N STE 100
Second Line	:
City	:	OKATIE
State	:	SC
Zip	:	29909-3782
Country	:	US
Telephone Number	:	843-706-8840
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/08/2021
Last Update Date	:	02/13/2025

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Directions to “ TAMMY SUE PAGE ” Practice Location

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