Healthcare Provider Details

I. General information

NPI: 1477429264
Provider Name (Legal Business Name): TANGELA DALTON CNA1 MED AIDE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1274
COOLEEMEE NC
27014-1274
US

IV. Provider business mailing address

279 DUKE ST # 1274
COOLEEMEE NC
27014-0078
US

V. Phone/Fax

Practice location:
  • Phone: 336-769-7092
  • Fax:
Mailing address:
  • Phone: 336-769-7092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number314313
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: