Provider Demographics
NPI:1699727214
Name:TATTERSALL-COCKE, ANA (CNS, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:TATTERSALL-COCKE
Suffix:
Gender:F
Credentials:CNS, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7330 SAN PEDRO AVE
Mailing Address - Street 2:#540
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-3901
Mailing Address - Country:US
Mailing Address - Phone:210-358-8555
Mailing Address - Fax:
Practice Address - Street 1:535 SE WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OR
Practice Address - Zip Code:97123-4142
Practice Address - Country:US
Practice Address - Phone:503-755-6703
Practice Address - Fax:503-755-6704
Is Sole Proprietor?:No
Enumeration Date:2006-05-16
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP109816363L00000X, 364S00000X, 364SA2200X
OR10023633363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX344932OtherAACC-ACNS-BS
TX153807604Medicaid
TX153807605OtherCSHCN
TX153807601Medicaid
TX153807605OtherCSHCN
TX153807604Medicaid