Provider Demographics
NPI:1114308103
Name:TATANGELO, CHARLOTTE ROSE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:CHARLOTTE
Middle Name:ROSE
Last Name:TATANGELO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:CHARLOTTE
Other - Middle Name:ROSE
Other - Last Name:KOLBICZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:5800 FOREMOST DR SE STE 300
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546-7062
Mailing Address - Country:US
Mailing Address - Phone:616-954-9800
Mailing Address - Fax:
Practice Address - Street 1:6425 S HARVEY ST
Practice Address - Street 2:
Practice Address - City:NORTON SHORES
Practice Address - State:MI
Practice Address - Zip Code:49444-9739
Practice Address - Country:US
Practice Address - Phone:231-737-3469
Practice Address - Fax:231-737-4548
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704243704363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily