Provider Demographics
NPI:1386255081
Name:ROCK-CARRENO, TATIANA D (WHNP-BC)
Entity type:Individual
Prefix:
First Name:TATIANA
Middle Name:D
Last Name:ROCK-CARRENO
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:TATIANA
Other - Middle Name:DULCE
Other - Last Name:ROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:500 SHEPHERD ST
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103-1633
Mailing Address - Country:US
Mailing Address - Phone:774-888-7618
Mailing Address - Fax:
Practice Address - Street 1:3991 DUTCHMANS LN STE 405
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4723
Practice Address - Country:US
Practice Address - Phone:502-899-3366
Practice Address - Fax:502-899-6686
Is Sole Proprietor?:No
Enumeration Date:2020-08-14
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013439363L00000X, 363LW0102X
KY3016381363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner