Provider Demographics
NPI:1326724964
Name:ABENI, TATIANNA TAHEERAH ELAINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TATIANNA
Middle Name:TAHEERAH ELAINE
Last Name:ABENI
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 MATISSE DR, APT 5028
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76107
Mailing Address - Country:US
Mailing Address - Phone:214-402-9365
Mailing Address - Fax:
Practice Address - Street 1:2504 RIDGE RD STE 203
Practice Address - Street 2:
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-2571
Practice Address - Country:US
Practice Address - Phone:972-588-4833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1127167363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily