Provider Demographics
NPI:1104486927
Name:WHITEN, TAMICA MICHELLE (AGACNP-BC, FNP-BC)
Entity type:Individual
Prefix:
First Name:TAMICA
Middle Name:MICHELLE
Last Name:WHITEN
Suffix:
Gender:F
Credentials:AGACNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 GOLDFINCH WAY
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-9028
Mailing Address - Country:US
Mailing Address - Phone:678-230-5436
Mailing Address - Fax:
Practice Address - Street 1:531 GOLDFINCH WAY
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-9028
Practice Address - Country:US
Practice Address - Phone:678-230-5436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-14
Last Update Date:2019-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN150889363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care