Provider Demographics
NPI:1033990593
Name:PARKER, TAVONDA S (RN, CPC)
Entity Type:Individual
Prefix:
First Name:TAVONDA
Middle Name:S
Last Name:PARKER
Suffix:
Gender:F
Credentials:RN, CPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5415 MEMORIAL LN
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-8020
Mailing Address - Country:US
Mailing Address - Phone:336-457-0405
Mailing Address - Fax:
Practice Address - Street 1:5415 MEMORIAL LN
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27407-8020
Practice Address - Country:US
Practice Address - Phone:336-457-0405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-11
Last Update Date:2023-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC228289163WC1500X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health