MEDICARE: MRS. TAMMY JIBBEN WINGO F.N.P.

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	363LF0000X	Family Nurse Practitioner	0024129303	VA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	C09816	OTHER	VA	MEDICARE GROUP NO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0024129303	OTHER	VA	LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639172182
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TAMMY JIBBEN WINGO F.N.P.

Provider Business Mailing Address
First Line	:	PO BOX 585
Second Line	:
City	:	FARMVILLE
State	:	VA
Zip	:	23901-0585
Country	:	US
Telephone Number	:	434-394-2422
Fax Number	:	434-394-2435

Provider Business Practice Location Address
First Line	:	1100 W 3RD ST
Second Line	:
City	:	FARMVILLE
State	:	VA
Zip	:	23901-2628
Country	:	US
Telephone Number	:	434-394-2422
Fax Number	:	434-394-2435

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

Provider Enumeration Date	:	05/28/2005
Last Update Date	:	03/07/2023

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