Provider Demographics
NPI:1043762453
Name:TAMALA, NELSON PALARPALAR JR (FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:NELSON
Middle Name:PALARPALAR
Last Name:TAMALA
Suffix:JR
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10450 SOUTHWEST HWY APT 1K
Mailing Address - Street 2:
Mailing Address - City:CHICAGO RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60415-1465
Mailing Address - Country:US
Mailing Address - Phone:708-465-7036
Mailing Address - Fax:
Practice Address - Street 1:10450 SOUTHWEST HWY APT 1K
Practice Address - Street 2:
Practice Address - City:CHICAGO RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60415-1465
Practice Address - Country:US
Practice Address - Phone:708-465-7036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-02
Last Update Date:2016-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209015058364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health