Provider Demographics
NPI:1003821166
Name:JATINEN, ELLEN B (NP)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:B
Last Name:JATINEN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6836 BEE CAVES RD
Mailing Address - Street 2:BLDG. 3 STE. 150
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746-5059
Mailing Address - Country:US
Mailing Address - Phone:512-375-2555
Mailing Address - Fax:512-485-1053
Practice Address - Street 1:6836 BEE CAVES RD
Practice Address - Street 2:BLDG. 3 STE. 150
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5059
Practice Address - Country:US
Practice Address - Phone:512-375-2555
Practice Address - Fax:512-485-1053
Is Sole Proprietor?:No
Enumeration Date:2006-07-29
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP110073363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158616606Medicaid
TX158616601Medicaid
TX158616603Medicaid
TX158616604Medicaid
TX158616604Medicaid
TX8L20234Medicare PIN
TX8A3786Medicare PIN