Provider Demographics
NPI:1164087417
Name:HATTORI, TOMOKO (CNS)
Entity Type:Individual
Prefix:
First Name:TOMOKO
Middle Name:
Last Name:HATTORI
Suffix:
Gender:F
Credentials:CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12701 RR 620 N STE 101
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1141
Mailing Address - Country:US
Mailing Address - Phone:512-593-6022
Mailing Address - Fax:512-593-9130
Practice Address - Street 1:12701 RR 620 N STE 101
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1141
Practice Address - Country:US
Practice Address - Phone:512-593-6022
Practice Address - Fax:512-593-9130
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139857364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX903504OtherRN
TXAP139857OtherAPRN