Healthcare Provider Details

I. General information

NPI: 1043762453
Provider Name (Legal Business Name): NELSON PALARPALAR TAMALA JR. FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2016
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10450 SOUTHWEST HWY APT 1K
CHICAGO RIDGE IL
60415-1465
US

IV. Provider business mailing address

10450 SOUTHWEST HWY APT 1K
CHICAGO RIDGE IL
60415-1465
US

V. Phone/Fax

Practice location:
  • Phone: 708-465-7036
  • Fax:
Mailing address:
  • Phone: 708-465-7036
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number277001972
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277001972
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: