Provider Demographics
NPI:1275671802
Name:TAMAJONG, ERNEST (NP)
Entity Type:Individual
Prefix:MR
First Name:ERNEST
Middle Name:
Last Name:TAMAJONG
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 WRANGLE HILL RD
Mailing Address - Street 2:STE 220
Mailing Address - City:BEAR
Mailing Address - State:DE
Mailing Address - Zip Code:19701-3837
Mailing Address - Country:US
Mailing Address - Phone:302-437-6833
Mailing Address - Fax:
Practice Address - Street 1:2500 WRANGLE HILL RD
Practice Address - Street 2:STE 220
Practice Address - City:BEAR
Practice Address - State:DE
Practice Address - Zip Code:19701-3837
Practice Address - Country:US
Practice Address - Phone:302-437-6833
Practice Address - Fax:302-455-8550
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016143363LA2200X
DELP-0000155363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health