Provider Demographics
NPI:1285058867
Name:GARRIS, TAMARA LYNAE (LPN)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:LYNAE
Last Name:GARRIS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 CHESTERFIELD HWY STE A
Mailing Address - Street 2:
Mailing Address - City:CHERAW
Mailing Address - State:SC
Mailing Address - Zip Code:29520-3024
Mailing Address - Country:US
Mailing Address - Phone:704-294-5100
Mailing Address - Fax:
Practice Address - Street 1:121 CHESTERFIELD HWY STE A
Practice Address - Street 2:
Practice Address - City:CHERAW
Practice Address - State:SC
Practice Address - Zip Code:29520-3024
Practice Address - Country:US
Practice Address - Phone:704-294-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-18
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC038205164W00000X
251E00000X, 251F00000X, 251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No251F00000XAgenciesHome Infusion
No251J00000XAgenciesNursing Care