Provider Demographics
NPI:1093200271
Name:TAH, YVONNE VERLA (FNP)
Entity Type:Individual
Prefix:
First Name:YVONNE
Middle Name:VERLA
Last Name:TAH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9159 PERSEVERANCE DR
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28075-8388
Mailing Address - Country:US
Mailing Address - Phone:651-226-1461
Mailing Address - Fax:
Practice Address - Street 1:701 E ROOSEVELT BLVD STE 800A
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-5187
Practice Address - Country:US
Practice Address - Phone:704-225-0211
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-29
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC229818363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty