Provider Demographics
NPI:1881238178
Name:TAPCHOM, ANGE BARLY (CRNA)
Entity type:Individual
Prefix:
First Name:ANGE
Middle Name:BARLY
Last Name:TAPCHOM
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 ARDLEY DR
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95747-9017
Mailing Address - Country:US
Mailing Address - Phone:734-781-5534
Mailing Address - Fax:
Practice Address - Street 1:3217 ARDLEY DR
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95747-9017
Practice Address - Country:US
Practice Address - Phone:734-781-5534
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-30
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN238664367500000X
CA95001269367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered