=====================================================
General NPI Number Information
=====================================================
NPI Number | 1528840840
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TANZZA MARIE BOWMAN FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/20/2023
-----------------------------------------------------
Last Update Date | 04/09/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 927 S LAFAYETTE ST
-----------------------------------------------------
City | SHELBY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28152-5851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-375-7465
-----------------------------------------------------
Fax | 704-600-6178
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 927 S LAFAYETTE ST
-----------------------------------------------------
City | SHELBY
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28152-5851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 980-375-7465
-----------------------------------------------------
Fax | 704-600-6178
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 5019009
-----------------------------------------------------
License Number State | NC
-----------------------------------------------------