MEDICARE: TAMMY CLEMMONS CRNP

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	363LA2200X	Adult Health Nurse Practitioner	1082123	AL

General Provider Information

NPI Number	:	1760751010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY CLEMMONS CRNP

Provider Business Mailing Address
First Line	:	325 CLOVERLEAF CIR
Second Line	:
City	:	KILLEN
State	:	AL
Zip	:	35645-7043
Country	:	US
Telephone Number	:	256-366-4343
Fax Number	:

Provider Business Practice Location Address
First Line	:	6920 MIRAMAR RD
Second Line	:	STE. 305
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-2632
Country	:	US
Telephone Number	:	858-935-7373
Fax Number	:

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

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	12/15/2011

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