Provider Demographics
NPI:1033242821
Name:TYSINGER, VIRGINIA CAMPBELL (RN,MS,CNS)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:CAMPBELL
Last Name:TYSINGER
Suffix:
Gender:F
Credentials:RN,MS,CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3329 HAWKINS AVE
Mailing Address - Street 2:
Mailing Address - City:SANFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27330-6942
Mailing Address - Country:US
Mailing Address - Phone:919-775-1659
Mailing Address - Fax:
Practice Address - Street 1:232 HIGH HOUSE RD
Practice Address - Street 2:
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27513-4203
Practice Address - Country:US
Practice Address - Phone:919-460-3370
Practice Address - Fax:919-460-3359
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC100210364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC6004052Medicaid