Provider Demographics
NPI:1043711591
Name:TASSI, ANITA TAH (RN)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:TAH
Last Name:TASSI
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 FOREST HOLLOW LN APT 1916
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76006-3069
Mailing Address - Country:US
Mailing Address - Phone:210-803-4199
Mailing Address - Fax:
Practice Address - Street 1:1314 LAKE ST STE 101
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-4582
Practice Address - Country:US
Practice Address - Phone:817-810-0660
Practice Address - Fax:817-810-0660
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2018-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX877256163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse