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General NPI Number Information
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NPI Number | 1073076923
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Entity Type | Individual
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Provider Name | TABITHA LECLAIRE TATE FNP
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Gender | Female
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Dates
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Enumeration Date | 04/08/2019
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Last Update Date | 01/22/2025
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Provider Practice Location Address
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Address Line | 421 FAYETTEVILLE ST STE 1100
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City | RALEIGH
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State | NC
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Zip | 27601-3000
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Country | US
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Telephone | 888-731-8994
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Fax |
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Provider Business Mailing Address
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Address Line | 2401 HUDLOW RD
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City | FOREST CITY
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State | NC
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Zip | 28043-7724
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Country | US
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Telephone | 828-980-4420
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 5011638
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | TPAN3027
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 29819
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 5011638
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License Number State | NC
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