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General NPI Number Information
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NPI Number | 1194792093
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Entity Type | Individual
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Provider Name | TAMARA HEGLAR GENTLE NP
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Gender | Female
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Dates
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Enumeration Date | 03/01/2006
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Last Update Date | 03/16/2023
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Provider Practice Location Address
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Address Line | 1000 COPPERFIELD BLVD NE STE 124
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City | CONCORD
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State | NC
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Zip | 28025-2454
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Country | US
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Telephone | 704-688-9641
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Fax | 704-960-4817
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Provider Business Mailing Address
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Address Line | 7004 SMITH CORNERS BLVD STE A
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City | CHARLOTTE
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State | NC
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Zip | 28269-3827
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Country | US
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Telephone | 704-688-9650
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Fax | 704-688-9651
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 900457
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 95127
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License Number State | NC
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