Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 4704203126 | MI |
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP3316 | AZ |
NPI | 1033201405 |
---|---|
Provider Name | Fatima Cabal Tagle |
First Address | Phoenix, AZ 85050-6934 |
Second Address | Phoenix, AZ 85032-4548 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/09/2006 |
Last Update Date | 08/04/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
470246910 | (05) | MI |
470247810 | (05) | MI |
FC203126 | BLUE SHIELD (01) | MI |
P00231988 | RR MEDICARE (01) | MI |
Q39330 | (02) |