Healthcare Provider Details

I. General information

NPI: 1780349159
Provider Name (Legal Business Name): ARIANNA LOUISE TALMADGE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2021
Last Update Date: 11/01/2021
Certification Date: 10/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 GIBSON BLVD SE APT 3068
ALBUQUERQUE NM
87106-3372
US

IV. Provider business mailing address

1801 GIBSON BLVD SE APT 3068
ALBUQUERQUE NM
87106-3372
US

V. Phone/Fax

Practice location:
  • Phone: 505-239-9929
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: