MEDICARE: TANGELLA FIELDS LPN

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	164W00000X	Licensed Practical Nurse	LPN070542	GA

General Provider Information

NPI Number	:	1952234080
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TANGELLA FIELDS LPN

Provider Business Mailing Address
First Line	:	3114 AUGUSTA TECH DR STE 7
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-3300
Country	:	US
Telephone Number	:	706-600-1060
Fax Number	:

Provider Business Practice Location Address
First Line	:	3114 AUGUSTA TECH DR STE 7
Second Line	:
City	:	AUGUSTA
State	:	GA
Zip	:	30906-3300
Country	:	US
Telephone Number	:	706-600-1060
Fax Number	:

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

Provider Enumeration Date	:	06/08/2026
Last Update Date	:	06/08/2026

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