Provider Demographics
NPI:1538329131
Name:RATLIFF, TAMEKIA BRIANNE (FNP)
Entity type:Individual
Prefix:
First Name:TAMEKIA
Middle Name:BRIANNE
Last Name:RATLIFF
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8749
Mailing Address - Country:US
Mailing Address - Phone:910-295-5511
Mailing Address - Fax:910-235-3421
Practice Address - Street 1:1411 GREENWAY CT
Practice Address - Street 2:
Practice Address - City:SANFORD
Practice Address - State:NC
Practice Address - Zip Code:27330-6954
Practice Address - Country:US
Practice Address - Phone:919-292-1201
Practice Address - Fax:919-292-1205
Is Sole Proprietor?:No
Enumeration Date:2008-06-17
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004176Medicaid
P00644091OtherRAILROAD MEDICARE PROVIDER #
NC7004176Medicaid