Provider Demographics
NPI:1629724380
Name:REAGAN, TANDY CLARISSA (APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:TANDY
Middle Name:CLARISSA
Last Name:REAGAN
Suffix:
Gender:F
Credentials:APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6433 TWIN OAKS DR
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-5923
Mailing Address - Country:US
Mailing Address - Phone:325-665-1274
Mailing Address - Fax:
Practice Address - Street 1:3101 S 27TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-6219
Practice Address - Country:US
Practice Address - Phone:325-704-5038
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1069496363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily