Provider Demographics
NPI:1841518255
Name:TAVAZIVA, PATRICIA (NP)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:
Last Name:TAVAZIVA
Suffix:
Gender:F
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:PO BOX 7867
Mailing Address - Street 2:
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-0867
Mailing Address - Country:US
Mailing Address - Phone:252-451-2700
Mailing Address - Fax:252-451-2702
Practice Address - Street 1:1041 NOELL LN
Practice Address - Street 2:SUITE 105
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-2058
Practice Address - Country:US
Practice Address - Phone:252-451-2700
Practice Address - Fax:252-451-2702
Is Sole Proprietor?:No
Enumeration Date:2010-05-10
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5004751363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7004730Medicaid
NC7004730Medicaid