Provider Demographics
NPI:1295697514
Name:TOLBERT, PAIGE A (NP)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:A
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:PAIGE
Other - Middle Name:A
Other - Last Name:JACOB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:92 W CHRISTMAS BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA CLAUS
Mailing Address - State:IN
Mailing Address - Zip Code:47579-6044
Mailing Address - Country:US
Mailing Address - Phone:812-937-4120
Mailing Address - Fax:
Practice Address - Street 1:92 W CHRISTMAS BLVD
Practice Address - Street 2:
Practice Address - City:SANTA CLAUS
Practice Address - State:IN
Practice Address - Zip Code:47579-6044
Practice Address - Country:US
Practice Address - Phone:812-937-4120
Practice Address - Fax:812-996-7074
Is Sole Proprietor?:No
Enumeration Date:2025-11-25
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71017437A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner