Nathan David Tavolieri, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA9103339 Issued in FL

Practice address

300 W Hospital Rd
Building 329
Fort Gordon, GA 30905-5741

Phone

(706) 787-3805

NPI assigned

Mar 31, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in GA

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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

• Medlink Management Services Inc

  • Critical Access Hospital
  • Lake Butler, FL
  • NPI 1013972272
  NPD (past)
• North Florida Emergency Physicians

  • Emergency Medicine Physician
  • Lake City, FL
  • NPI 1538251186
  NPD (past)

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

{
    "created_epoch": "1143763200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1380758400000",
    "number": "1063473510",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "300 W HOSPITAL RD",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055741",
            "telephone_number": "706-787-3805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 W HOSPITAL RD",
            "address_2": "BUILDING 329",
            "city": "FORT GORDON",
            "state": "GA",
            "postal_code": "309055741",
            "telephone_number": "706-787-3805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TAVOLIERI",
        "first_name": "NATHAN",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-31",
        "last_updated": "2013-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9103339",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2921839-00",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Joseph Scott Swanstrom, LICSW
• William Joseph Sweeney
• Ryan Dale Swiss, DDS
• Stevon Ronald Sykes
• Elizabeth Michelle Sylvester, RN
• Ronald B. Terry, DMD
• Genver Thomas, ARNP
• William Akins Thomas Jr., M.D.
• Toya Tawyna Thorpe, OTR/L
• Daniel Ticona, RDN

• Physician Assistant in Fort Gordon, GA
• Providers in Fort Gordon, GA by specialty
• Physician Assistant in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2013; 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.