Provider Demographics
NPI:1588069561
Name:AFTANAS, TAMMY LYNN (NP-C)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:AFTANAS
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1228 HANLIN WAY
Mailing Address - Street 2:
Mailing Address - City:WEIRTON
Mailing Address - State:WV
Mailing Address - Zip Code:26062-4335
Mailing Address - Country:US
Mailing Address - Phone:304-670-4535
Mailing Address - Fax:
Practice Address - Street 1:1228 HANLIN WAY
Practice Address - Street 2:
Practice Address - City:WEIRTON
Practice Address - State:WV
Practice Address - Zip Code:26062-4335
Practice Address - Country:US
Practice Address - Phone:304-670-4535
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPPLIED FOR363LF0000X
OHAPPLIED FOR363LF0000X
PAAPPLIED FOR363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily