Healthcare Provider Details

I. General information

NPI: 1689056806
Provider Name (Legal Business Name): JENNIFER LYNN TANGEMAN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2015
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3801 BARRETT DR
RALEIGH NC
27609-7224
US

IV. Provider business mailing address

3801 BARRETT DR
RALEIGH NC
27609-7224
US

V. Phone/Fax

Practice location:
  • Phone: 919-870-8409
  • Fax: 877-622-8953
Mailing address:
  • Phone: 919-870-8409
  • Fax: 877-622-8953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5007713
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: