Individual
TAMARA HEGLAR GENTLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
900457
NC
363LA2200X
Adult Health Nurse Practitioner
Primary
95127
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1194792093
—
NC
01
—
566000156
OCCUPATIONAL MED TAX ID
NC
01
—
NCB984A
MEDICARE PTAN INDIVIDUAL, EFF 2/23/13
NC
Enumeration date
03/01/2006
Last updated
03/16/2023
Update your record
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