Provider Demographics
NPI:1437567021
Name:CHAMBLISS, TAGI (RN)
Entity Type:Individual
Prefix:
First Name:TAGI
Middle Name:
Last Name:CHAMBLISS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:945 TELLER AVE APT 5D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3429
Mailing Address - Country:US
Mailing Address - Phone:704-351-7585
Mailing Address - Fax:
Practice Address - Street 1:945 TELLER AVE APT 5D
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-3429
Practice Address - Country:US
Practice Address - Phone:704-351-7585
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-27
Last Update Date:2014-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY685818163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse