Provider Demographics
NPI:1891829156
Name:TAMBERELLI, WAYNE PAUL (PA-C)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:PAUL
Last Name:TAMBERELLI
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 W NASHVILLE DR STE A
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27856-1289
Mailing Address - Country:US
Mailing Address - Phone:252-822-3583
Mailing Address - Fax:
Practice Address - Street 1:107 W NASHVILLE DR STE A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:NC
Practice Address - Zip Code:27856-1289
Practice Address - Country:US
Practice Address - Phone:252-822-3583
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC000100379363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical