Basic Information
| Provider Information | |||||||||
| NPI: | 1952777559 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OUELLETTE | ||||||||
| FirstName: | TINA | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | FNP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1021 DARRINGTON DR STE 101 | ||||||||
| Address2: | |||||||||
| City: | CARY | ||||||||
| State: | NC | ||||||||
| PostalCode: | 275138158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9198523999 | ||||||||
| FaxNumber: | 9193789114 | ||||||||
| Practice Location | |||||||||
| Address1: | 6729 FALLS OF NEUSE RD | ||||||||
| Address2: | |||||||||
| City: | RALEIGH | ||||||||
| State: | NC | ||||||||
| PostalCode: | 276155287 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9199218219 | ||||||||
| FaxNumber: | 9193782161 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/18/2015 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 5007876 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.