Provider Demographics
NPI:1629071162
Name:TATALOS, STEPHANIE HELENE (RN, WHNP-BC)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:HELENE
Last Name:TATALOS
Suffix:
Gender:F
Credentials:RN, WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76209-4719
Mailing Address - Country:US
Mailing Address - Phone:940-566-5244
Mailing Address - Fax:
Practice Address - Street 1:3537 S I-35 E
Practice Address - Street 2:STE 210
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-6800
Practice Address - Country:US
Practice Address - Phone:940-381-2313
Practice Address - Fax:940-381-5249
Is Sole Proprietor?:No
Enumeration Date:2005-05-28
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX455586363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018463204Medicaid
TXS82405Medicare UPIN
TX8D1306Medicare ID - Type Unspecified