Provider Demographics
NPI:1700374246
Name:TANGAH, FELECITA
Entity Type:Individual
Prefix:
First Name:FELECITA
Middle Name:
Last Name:TANGAH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8631 GREENBELT RD APT T1
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-2408
Mailing Address - Country:US
Mailing Address - Phone:240-495-8698
Mailing Address - Fax:
Practice Address - Street 1:8631 GREENBELT RD APT T1
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-2408
Practice Address - Country:US
Practice Address - Phone:240-495-8698
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2018-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide