Provider Demographics
NPI:1518482710
Name:TAH, RAYMOND TANWANI (FNP)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:TANWANI
Last Name:TAH
Suffix:
Gender:M
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:980-258-0125
Mailing Address - Fax:980-258-0125
Practice Address - Street 1:9159 PERSEVERANCE DR
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:NC
Practice Address - Zip Code:28075-8388
Practice Address - Country:US
Practice Address - Phone:786-302-6062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2021-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251632163WM0705X
NC5009800363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical