Provider Demographics
NPI:1164903001
Name:MARCOS, GRACITA TAGARINO (RN)
Entity Type:Individual
Prefix:
First Name:GRACITA
Middle Name:TAGARINO
Last Name:MARCOS
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 1:5904 WORTHING
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-1994
Mailing Address - Country:US
Mailing Address - Phone:254-598-0201
Mailing Address - Fax:
Practice Address - Street 1:5904 WORTHING
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-1994
Practice Address - Country:US
Practice Address - Phone:254-598-0201
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-28
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX828028163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health