Provider Demographics
NPI:1487153110
Name:MONROE, TANGELA SHANEEN (NNP-BC)
Entity type:Individual
Prefix:
First Name:TANGELA
Middle Name:SHANEEN
Last Name:MONROE
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14088 NELSON HILL RD
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:VA
Mailing Address - Zip Code:22514-2013
Mailing Address - Country:US
Mailing Address - Phone:804-633-1018
Mailing Address - Fax:
Practice Address - Street 1:412 LIBBIE AVE STE 4
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-2658
Practice Address - Country:US
Practice Address - Phone:804-282-8082
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-08
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024175645363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal