Tanneh Paulenna Agboola, APN

Primary specialty

Gerontology Nurse PractitionerTaxonomy code 363LG0600X

License

26NJ00500900 Issued in NJ

Practice address

1435 Liberty St
Hamilton, NJ 08629-2220

Phone

(609) 599-5433

Fax

(609) 475-4662

NPI assigned

Sep 11, 2014

Last updated

Sep 11, 2014By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NJ, PA2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Alignmed Partners, PC

  dba GPS Physician Group PC

  • Geriatric Medicine (Internal Medicine) Physician
  • Gardendale, AL
  • NPI 1881109452

  PA

  Medicare reassignment NPD
• HCR Manorcare Medical Services of Florida LLC

  dba Heartland Care Partners

  • Nurse Practitioner
  • Toledo, OH
  • NPI 1386750420
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1410393600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410393600000",
    "number": "1013318864",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1435 LIBERTY ST",
            "city": "HAMILTON",
            "state": "NJ",
            "postal_code": "086292220",
            "telephone_number": "609-599-5433",
            "fax_number": "609-475-4662"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1435 LIBERTY ST",
            "city": "HAMILTON",
            "state": "NJ",
            "postal_code": "086292220",
            "telephone_number": "609-599-5433",
            "fax_number": "609-475-4662"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AGBOOLA",
        "first_name": "TANNEH",
        "middle_name": "PAULENNA",
        "credential": "APN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-09-11",
        "last_updated": "2014-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NJ",
            "license": "26NJ00500900",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Advanced Pain Management and Acupuncture LLC
• Advanced Spine and Pain, LLC (Relievus)
• Advocare , LLC (Advocare Quakerbridge Pediatrics)
• Advocare , LLC
• Advocate Primary Care
• Annabel Agcopra, DO
• Amanda Jean Agoglia
• Nelida Agosto, LPC
• Prima Ahamed, LCSW
• Sarfaraz Ahmad, MD

• Gerontology Nurse Practitioner in Hamilton, NJ
• Providers in Hamilton, NJ by specialty
• Gerontology Nurse Practitioner in New Jersey

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.