MEDICARE: ANNETTE GAY TARPLEY NP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	0024169054	VA

General Provider Information

NPI Number	:	1629370895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANNETTE GAY TARPLEY NP

Provider Business Mailing Address
First Line	:	4025 CRAWFORD RD
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24018-4419
Country	:	US
Telephone Number	:	540-776-1499
Fax Number	:

Provider Business Practice Location Address
First Line	:	2001 COLONIAL AVE SW
Second Line	:
City	:	ROANOKE
State	:	VA
Zip	:	24015-3210
Country	:	US
Telephone Number	:	540-342-1877
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	09/05/2013

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