Healthcare Provider Details

I. General information

NPI: 1245564194
Provider Name (Legal Business Name): MICHELLE A TENAGLIA RN, CNM,ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2009
Last Update Date: 04/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 PROVIDENCE RD
CHARLOTTE NC
28207-1206
US

IV. Provider business mailing address

254 BAMBOO CREEK LN
MARS HILL NC
28754-6109
US

V. Phone/Fax

Practice location:
  • Phone: 704-750-5535
  • Fax: 888-335-2054
Mailing address:
  • Phone: 828-206-2935
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2000840579
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number731432
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number531
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: