Provider Demographics
NPI:1033387402
Name:MATEJKA, TAMARA ANN
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:ANN
Last Name:MATEJKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 SCHENCK PKWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28803-3499
Mailing Address - Country:US
Mailing Address - Phone:828-681-1527
Mailing Address - Fax:
Practice Address - Street 1:76 PEACHTREE ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28803-3505
Practice Address - Country:US
Practice Address - Phone:828-274-3477
Practice Address - Fax:828-274-7407
Is Sole Proprietor?:No
Enumeration Date:2008-02-19
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL079007367500000X
NC230674367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8053611Medicaid
NC2606508Medicare PIN