Provider Demographics
NPI:1063504934
Name:TATSAPAUGH, GLORIA JEANE (FNP)
Entity Type:Individual
Prefix:
First Name:GLORIA
Middle Name:JEANE
Last Name:TATSAPAUGH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1037 MAIN ST
Mailing Address - Street 2:CREDENTIALING DEPT.
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566-2913
Mailing Address - Country:US
Mailing Address - Phone:914-734-8858
Mailing Address - Fax:914-734-8786
Practice Address - Street 1:3174 ROUTE 22
Practice Address - Street 2:HUDSON RIVER HEALTHCARE, INC.
Practice Address - City:DOVER PLAINS
Practice Address - State:NY
Practice Address - Zip Code:12522-5924
Practice Address - Country:US
Practice Address - Phone:845-877-4793
Practice Address - Fax:845-877-9212
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY302509363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473038Medicaid
NY02328870Medicaid
NYA400042752Medicare PIN