Healthcare Provider Details

I. General information

NPI: 1346371663
Provider Name (Legal Business Name): TAMMY L MEDLIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMMY L HOSTETLER

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 BAYLOR DR STE 155
BLUFFTON SC
29910-8965
US

IV. Provider business mailing address

1010 MEDICAL CENTER DR # 200
HARDEEVILLE SC
29927-3447
US

V. Phone/Fax

Practice location:
  • Phone: 843-706-2523
  • Fax:
Mailing address:
  • Phone: 843-645-8220
  • Fax: 843-645-8221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN112985
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN112985NP
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20432
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: