Provider Demographics
NPI:1386415784
Name:TARACATAC, MARIA THERESA NACOR (FNP-C)
Entity type:Individual
Prefix:
First Name:MARIA THERESA
Middle Name:NACOR
Last Name:TARACATAC
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARIA THERESA
Other - Middle Name:DANAO
Other - Last Name:NACOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:591 TELEGRAPH CANYON RD # 601
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91910-6436
Mailing Address - Country:US
Mailing Address - Phone:619-494-7412
Mailing Address - Fax:
Practice Address - Street 1:435 H ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-4307
Practice Address - Country:US
Practice Address - Phone:619-494-7412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-15
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027963363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty