Provider Demographics
NPI:1528945532
Name:VLASIC, JAMIE TANNER (DNP, WHNP-BC, MSCP)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:TANNER
Last Name:VLASIC
Suffix:
Gender:X
Credentials:DNP, WHNP-BC, MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20024 SCHOONER DR
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-5865
Mailing Address - Country:US
Mailing Address - Phone:847-636-1575
Mailing Address - Fax:
Practice Address - Street 1:9624 BAILEY RD STE 285
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-6124
Practice Address - Country:US
Practice Address - Phone:847-636-1575
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5022893363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health