Park, Tammera L

Park, Tammera L is an individual health care provider with primary practice located at 101 Wilkesboro St Ste B , Mocksville NC 27028-2321. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as her primary health care specialty. Park, Tammera L can be contacted via phone (336) 753-0800.

Contact Information

Primary practice address
101 Wilkesboro St Ste B Mocksville NC 27028-2321
Phone: (336) 753-0800
Fax: (336) 753-0805
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2054 Colorado

Profile Details

NPI number 1598853129
LBN Legal business name Park, Tammera L
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 10th, 2006
Last updated Jan 7th, 2021 - about 5 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1598853129 NPPES
Colorado MEDICAID 04020954
Colorado Other 261227YLQP

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