Provider Demographics
NPI:1336775337
Name:MASTEN, TITISHA
Entity type:Individual
Prefix:
First Name:TITISHA
Middle Name:
Last Name:MASTEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TITISHA
Other - Middle Name:
Other - Last Name:COCHRAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:21227 TORCH STREET
Mailing Address - Street 2:
Mailing Address - City:BIGGS FIELD
Mailing Address - State:TX
Mailing Address - Zip Code:79918-0362
Mailing Address - Country:US
Mailing Address - Phone:915-569-4287
Mailing Address - Fax:915-237-8760
Practice Address - Street 1:21227 TORCH STREET
Practice Address - Street 2:
Practice Address - City:BIGGS FIELD
Practice Address - State:TX
Practice Address - Zip Code:79918
Practice Address - Country:US
Practice Address - Phone:915-569-4287
Practice Address - Fax:915-237-8760
Is Sole Proprietor?:No
Enumeration Date:2020-03-21
Last Update Date:2023-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171000000X
GARN208809363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No171000000XOther Service ProvidersMilitary Health Care Provider