Provider Demographics
NPI:1487105763
Name:TOLBERT, INEKE ANASTASIA (ACNP)
Entity type:Individual
Prefix:
First Name:INEKE
Middle Name:ANASTASIA
Last Name:TOLBERT
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:554 MEMORIAL DRIVE EXT STE D
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29651-1155
Mailing Address - Country:US
Mailing Address - Phone:864-479-1440
Mailing Address - Fax:
Practice Address - Street 1:554 MEMORIAL DRIVE EXT STE D
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29651-1155
Practice Address - Country:US
Practice Address - Phone:864-612-5159
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC20544363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care