Healthcare Provider Details

I. General information

NPI: 1114693322
Provider Name (Legal Business Name): TAMMY RENAE FISHER RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 08/18/2021
Certification Date: 08/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 MARRIOTT DR
NASHVILLE TN
37214-5048
US

IV. Provider business mailing address

616 MARRIOTT DR
NASHVILLE TN
37214-5048
US

V. Phone/Fax

Practice location:
  • Phone: 629-802-3226
  • Fax:
Mailing address:
  • Phone: 629-802-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License Number7449
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: