MS. JEANINE MARIE TACKLA APRN MSN A-GNP-C NPI 1255612537

NPI Information

NPI: 1255612537
Provider Name: MS. JEANINE MARIE TACKLA, APRN, MSN, A-GNP-C,
Classification: Nurse Practitioner - 363LG0600X
Entity Type: Individual

Specialization: Gerontology

PECOS Registration: Yes

Address:
800 MEDICAL CENTER DR STE C
DECATUR, TX
ZIP 76234
Phone: (940) 626-2110
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MS. Jeanine Marie Tackla, APRN, MSN, A-GNP-C, is a gerontology nurse practitioner in Decatur, TX with 2 years of experience. MS. Jeanine Marie Tackla, APRN, MSN, A-GNP-C, NPI is 1255612537. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

800 MEDICAL CENTER DR STE C
DECATUR, TX
ZIP 76234-844
Phone: (940) 626-2110
Fax: (940) 626-2113

The NPI 1255612537 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 8/31/2011 and was last updated on 9/14/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	163WR0006X	Registered Nurse	Registered Nurse First Assistant	095692	ILLINOIS	No
2	363LG0600X	Nurse Practitioner	Gerontology	1114749	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	041214374	OTHER	ILLINOIS	REGISTERED PROFESSIONAL NURSE
2	95094533	OTHER	CALIFORNIA	REGISTERED PROFESSIONAL NURSE
3	095692	OTHER		CNOR, CRNFA
4	1114749	OTHER	TEXAS	APRN-CNP
5	915559	OTHER	TEXAS	REGISTERED PROFESSIONAL NURSE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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