Healthcare Provider Details

I. General information

NPI: 1194792093
Provider Name (Legal Business Name): TAMARA HEGLAR GENTLE NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TAMARA HEGLAR WILLIAMS

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 03/16/2023
Certification Date: 03/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 COPPERFIELD BLVD NE STE 124
CONCORD NC
28025-2454
US

IV. Provider business mailing address

7004 SMITH CORNERS BLVD STE A
CHARLOTTE NC
28269-3827
US

V. Phone/Fax

Practice location:
  • Phone: 704-688-9641
  • Fax: 704-960-4817
Mailing address:
  • Phone: 704-688-9650
  • Fax: 704-688-9651

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number900457
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95127
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: