Basic Information
| Provider Information | |||||||||
| NPI: | 1932618121 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TOBIAS | ||||||||
| FirstName: | EMILY | ||||||||
| MiddleName: | COMMACK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1616 E MILLBROOK RD STE 110 | ||||||||
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| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276094971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193414016 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1899 N MARINE BLVD | ||||||||
| Address2: | |||||||||
| City: | JACKSONVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 285466534 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9109377200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/20/2017 | ||||||||
| LastUpdateDate: | 10/21/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 10/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5013647 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.