Provider Demographics
NPI:1033103981
Name:MARQUARDT, TOSHA ADAMS (PA-C)
Entity type:Individual
Prefix:
First Name:TOSHA
Middle Name:ADAMS
Last Name:MARQUARDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:TOSHA
Other - Middle Name:A
Other - Last Name:HAMNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2111 NEUSE BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-4318
Mailing Address - Country:US
Mailing Address - Phone:252-636-0300
Mailing Address - Fax:
Practice Address - Street 1:2111 NEUSE BLVD STE J
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28560-4318
Practice Address - Country:US
Practice Address - Phone:252-636-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN3180363A00000X
MSPA031363A00000X
OK2238363A00000X
CO4572363A00000X
NC363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06377709Medicaid
OK200502800AMedicaid
1033103981OtherNPI
MSS41828Medicare UPIN