Provider Demographics
NPI:1073376984
Name:BRUGGEMAN, TAMI JO (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:JO
Last Name:BRUGGEMAN
Suffix:
Gender:
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 935983
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:31193-5983
Mailing Address - Country:US
Mailing Address - Phone:336-515-7060
Mailing Address - Fax:336-515-7069
Practice Address - Street 1:1730 KERNERSVILLE MEDICAL PKWY STE 201
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-7198
Practice Address - Country:US
Practice Address - Phone:336-515-7060
Practice Address - Fax:336-515-7069
Is Sole Proprietor?:No
Enumeration Date:2024-02-02
Last Update Date:2025-03-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC5019552363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner