Healthcare Provider Details

I. General information

NPI: 1205201647
Provider Name (Legal Business Name): CARRIE AMICI TINGLEY AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2015
Last Update Date: 08/06/2024
Certification Date: 08/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 COWELL FARM RD
WASHINGTON NC
27889-3431
US

IV. Provider business mailing address

1380 COWELL FARM RD
WASHINGTON NC
27889-3431
US

V. Phone/Fax

Practice location:
  • Phone: 252-946-2101
  • Fax: 252-946-9896
Mailing address:
  • Phone: 252-946-2101
  • Fax: 252-946-9896

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number5008243
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: