Provider Demographics
NPI:1558765040
Name:TRIBOLET, TAMARYN PARKS (PA-C)
Entity type:Individual
Prefix:
First Name:TAMARYN
Middle Name:PARKS
Last Name:TRIBOLET
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:TAMARYN
Other - Middle Name:
Other - Last Name:PARKS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:293 INDEPENDENCE BLVD
Mailing Address - Street 2:PEMBROKE 5, SUITE 330
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462
Mailing Address - Country:US
Mailing Address - Phone:757-222-3100
Mailing Address - Fax:
Practice Address - Street 1:293 INDEPENDENCE BLVD
Practice Address - Street 2:PEMBROKE 5, SUITE 330
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23462
Practice Address - Country:US
Practice Address - Phone:757-222-3100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2025-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA09469363A00000X
VA0110006015363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAVVR782AOtherMEDICARE PIN
TX342064801Medicaid