Provider Demographics
NPI:1932948577
Name:TAGAYUNA, MA TERESITA
Entity type:Individual
Prefix:
First Name:MA TERESITA
Middle Name:
Last Name:TAGAYUNA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TETCHIE
Other - Middle Name:
Other - Last Name:TAGAYUNA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:AGNP-C
Mailing Address - Street 1:2801 LEMMON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2314
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2801 LEMMON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2314
Practice Address - Country:US
Practice Address - Phone:469-531-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-22
Last Update Date:2024-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX708103163WM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical