Provider Demographics
NPI:1134217003
Name:TATE, PAMELA GAIL (BSN, CRNP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:GAIL
Last Name:TATE
Suffix:
Gender:F
Credentials:BSN, CRNP
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:GAIL
Other - Last Name:TATE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CRNP
Mailing Address - Street 1:PO BOX 10005
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35631-2005
Mailing Address - Country:US
Mailing Address - Phone:256-764-7888
Mailing Address - Fax:256-760-1020
Practice Address - Street 1:162 TITAN DR
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-1197
Practice Address - Country:US
Practice Address - Phone:256-764-7888
Practice Address - Fax:256-760-1020
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-033395363LX0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL181855Medicaid
ALS90877Medicare UPIN
AL181855Medicaid