Individual
TAMMY VINCENT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
14116 CUSTOMS BLVD, GULFPORT, MS 39503-5164
(601) 957-6300
Mailing address
422 MEMORIAL BLVD, PICAYUNE, MS 39466-5544
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
R872175
MS
Other
Enumeration date
10/28/2015
Last updated
10/25/2019
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