Healthcare Provider Details

I. General information

NPI: 1154623965
Provider Name (Legal Business Name): ARNETTE OLIVIA TATES DNP, FNP-BC,PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2010
Last Update Date: 08/16/2026
Certification Date: 08/16/2026
Deactivation Date: 07/09/2026
Reactivation Date: 08/14/2026

III. Provider practice location address

905 HALSTEAD BLVD STE 16
ELIZABETH CITY NC
27909-6816
US

IV. Provider business mailing address

905 HALSTEAD BLVD STE 16
ELIZABETH CITY NC
27909-6816
US

V. Phone/Fax

Practice location:
  • Phone: 855-252-4870
  • Fax: 855-434-2525
Mailing address:
  • Phone: 855-252-4870
  • Fax: 855-434-2525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5004744
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: