Provider Demographics
NPI:1245564194
Name:TENAGLIA, MICHELLE A (RN, CNM,ANP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:A
Last Name:TENAGLIA
Suffix:
Gender:F
Credentials:RN, CNM,ANP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 BAMBOO CREEK LN
Mailing Address - Street 2:
Mailing Address - City:MARS HILL
Mailing Address - State:NC
Mailing Address - Zip Code:28754-6109
Mailing Address - Country:US
Mailing Address - Phone:828-206-2935
Mailing Address - Fax:
Practice Address - Street 1:131 PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1206
Practice Address - Country:US
Practice Address - Phone:704-750-5535
Practice Address - Fax:888-335-2054
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-24
Last Update Date:2016-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2000840579163W00000X
TX731432367A00000X
NC531367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163W00000XNursing Service ProvidersRegistered Nurse