Provider Demographics
NPI:1245613280
Name:TATUM, MAROCKA
Entity Type:Individual
Prefix:
First Name:MAROCKA
Middle Name:
Last Name:TATUM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAROCKA
Other - Middle Name:
Other - Last Name:TATUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:23114 HARPERGATE DR
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77373-6856
Mailing Address - Country:US
Mailing Address - Phone:832-560-8361
Mailing Address - Fax:
Practice Address - Street 1:23114 HARPERGATE DR
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77373-6856
Practice Address - Country:US
Practice Address - Phone:832-560-8361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-08
Last Update Date:2015-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX794368163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse