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General NPI Number Information
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NPI Number | 1366096034
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Entity Type | Individual
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Provider Name | TAMMY FUSILIER CRNP
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Gender | Female
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Dates
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Enumeration Date | 07/30/2019
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Last Update Date | 04/15/2024
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Provider Practice Location Address
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Address Line | 173 SAINT PATRICKS DR STE 104
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City | WALDORF
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State | MD
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Zip | 20603-5530
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Country | US
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Telephone | 240-729-6250
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Fax | 949-695-4106
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Provider Business Mailing Address
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Address Line | 173 SAINT PATRICKS DR STE 104
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City | WALDORF
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State | MD
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Zip | 20603-5530
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Country | US
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Telephone | 240-729-6250
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Fax | 949-695-4106
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | R215486
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License Number State | MD
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