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NPI Code Detail

MEDICARE: NICOLE MARIE TROMBETTA PA-C

MEDICARE: NICOLE MARIE TROMBETTA PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantNC
2363A00000XPhysician Assistant0010-09502NC

General Provider Information

NPI Number : 1548819774
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE MARIE TROMBETTA PA-C
Provider Business Mailing Address
First Line : PO BOX 751803
Second Line :
City : CHARLOTTE
State : NC
Zip : 28275-1803
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1225 LEWISVILLE CLEMMONS RD
Second Line :
City : LEWISVILLE
State : NC
Zip : 27023-8251
Country : US
Telephone Number : 336-712-0700
Fax Number : 336-712-0876
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2019
Last Update Date : 09/08/2021

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Directions to “ NICOLE MARIE TROMBETTA PA-C” Practice Location

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