Individual
MRS. JOAN LAVONNE TACKETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APN
Contact information
Practice address
1007 SUMMIT AVE, GREENSBORO, NC 27405-7007
(336) 200-7010
Mailing address
PO BOX 746724, ATLANTA, GA 30374-6724
(312) 733-9730
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5016176
NC
363LF0000X
Family Nurse Practitioner
A03553ANP
AR
Other
Enumeration date
03/28/2012
Last updated
03/17/2025
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