Individual
TAMMY SHALLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
231 OCEAN JASPER DR, ST AUGUSTINE, FL 32086-8092
(904) 826-7007
Mailing address
231 OCEAN JASPER DR, ST AUGUSTINE, FL 32086-8092
(904) 826-7007
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
080347
CT
163W00000X
Registered Nurse
Primary
RN9262129
FL
Other
Enumeration date
03/14/2007
Last updated
07/03/2023
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