Provider Demographics
NPI:1053080721
Name:TIOTANGCO, MARC JOSEPH
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:JOSEPH
Last Name:TIOTANGCO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4003 113TH DR SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-5593
Mailing Address - Country:US
Mailing Address - Phone:425-268-6634
Mailing Address - Fax:
Practice Address - Street 1:4003 113TH DR SE
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-5593
Practice Address - Country:US
Practice Address - Phone:425-268-6634
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WARN61055691163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse