MEDICARE: TAMMY LYNN BAERGEN-WHITE RN

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	163WA2000X	Administrator Registered Nurse	9313985	FL
2	163WA2000X	Administrator Registered Nurse	604719	TX
3	163WA2000X	Administrator Registered Nurse	1-1497171	AL

General Provider Information

NPI Number	:	1306232780
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY LYNN BAERGEN-WHITE RN

Provider Business Mailing Address
First Line	:	1794 PALISADES DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-6330
Country	:	US
Telephone Number	:	817-925-9416
Fax Number	:

Provider Business Practice Location Address
First Line	:	1794 PALISADES DR
Second Line	:
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33411-6330
Country	:	US
Telephone Number	:	817-925-9416
Fax Number	:

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

Provider Enumeration Date	:	04/12/2015
Last Update Date	:	04/12/2015

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