Provider Demographics
NPI:1750951414
Name:SIMMONS, TANNISHA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:TANNISHA
Middle Name:
Last Name:SIMMONS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 JOHNSON FERRY RD # 7044
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4628
Mailing Address - Country:US
Mailing Address - Phone:770-997-9220
Mailing Address - Fax:
Practice Address - Street 1:687 JOHNSON FERRY RD # 7044
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4628
Practice Address - Country:US
Practice Address - Phone:770-997-9220
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-25
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN302333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN302333OtherGABON