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NPI Code Detail

MEDICARE: TANGULA LATRICE SIMMONS NP

MEDICARE: TANGULA LATRICE SIMMONS NP
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
1363L00000XNurse Practitioner5005889NC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1609120690
Entity Type Code : Individual
Provider Name (Legal Business Name) : TANGULA LATRICE SIMMONS NP
Provider Business Mailing Address
First Line : PO BOX 60447
Second Line :
City : CHARLOTTE
State : NC
Zip : 28260-0447
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 501 HICKORY BRANCH RD
Second Line :
City : GREENSBORO
State : NC
Zip : 27409-9601
Country : US
Telephone Number : 336-878-2260
Fax Number : 336-878-2277
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/30/2012
Last Update Date : 08/04/2022

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Directions to “ TANGULA LATRICE SIMMONS NP” Practice Location

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