Basic Information
| Provider Information | |||||||||
| NPI: | 1316555311 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TABRON | ||||||||
| FirstName: | GLORIA | ||||||||
| MiddleName: | LASHANDA | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1596 | ||||||||
| Address2: | |||||||||
| City: | SPRING HOPE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278821596 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524587220 | ||||||||
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| Practice Location | |||||||||
| Address1: | 91 ENTERPRISE DR | ||||||||
| Address2: | |||||||||
| City: | ROCKY MOUNT | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278049590 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2524513100 | ||||||||
| FaxNumber: | 2529373106 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/16/2020 | ||||||||
| LastUpdateDate: | 07/27/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/27/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WW0000X | 203689 | NC | N | Nursing Service Providers | Registered Nurse | Wound Care | 363LF0000X | 203689 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.