Provider Demographics
NPI:1124323316
Name:TAMBA, MARTU TENNIH (NP)
Entity type:Individual
Prefix:MS
First Name:MARTU
Middle Name:TENNIH
Last Name:TAMBA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3404 ASHLEY VIEW DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28213-4951
Mailing Address - Country:US
Mailing Address - Phone:216-262-0524
Mailing Address - Fax:
Practice Address - Street 1:3404 ASHLEY VIEW DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-4951
Practice Address - Country:US
Practice Address - Phone:216-262-0524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-19
Last Update Date:2022-04-08
Deactivation Date:2011-03-02
Deactivation Code:
Reactivation Date:2018-09-21
Provider Licenses
StateLicense IDTaxonomies
NC5011136363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner