Healthcare Provider Details

I. General information

NPI: 1962811471
Provider Name (Legal Business Name): TAMMY ELIZABETH HIOTT NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2014
Last Update Date: 04/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 EAGLE LANDING BOULEVARD AGAPE PHYSICIANS CARE AT HEARTLAND OF HANAHAN
HANAHAN SC
29410
US

IV. Provider business mailing address

1624 MAIN STREET AGAPE SENIOR PRIMARY CARE, INC., DBA AGAPE PHYSICAINS C
COLUMBIA SC
29201
US

V. Phone/Fax

Practice location:
  • Phone: 843-553-0656
  • Fax:
Mailing address:
  • Phone: 803-454-0365
  • Fax: 803-404-6000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number18827
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: