Provider Demographics
NPI:1114687829
Name:TEDSEN, TAMMY M (AG-ACNP)
Entity type:Individual
Prefix:MS
First Name:TAMMY
Middle Name:M
Last Name:TEDSEN
Suffix:
Gender:F
Credentials:AG-ACNP
Other - Prefix:
Other - First Name:TAMMY
Other - Middle Name:MICHAELA
Other - Last Name:SIMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 749112
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:590 PETER JEFFERSON PKWY STE 175
Practice Address - Street 2:
Practice Address - City:CHARLOTTESVILLE
Practice Address - State:VA
Practice Address - Zip Code:22911-4655
Practice Address - Country:US
Practice Address - Phone:434-982-6900
Practice Address - Fax:434-982-8420
Is Sole Proprietor?:No
Enumeration Date:2021-12-21
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024182778207RH0003X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology