Provider Demographics
NPI:1760739130
Name:TAGUE, DEBRA (FNP-C)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:TAGUE
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:PO BOX 3276
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47731-3276
Mailing Address - Country:US
Mailing Address - Phone:812-491-1462
Mailing Address - Fax:812-492-6462
Practice Address - Street 1:4445 S 10TH ST
Practice Address - Street 2:
Practice Address - City:TERRE HAUTE
Practice Address - State:IN
Practice Address - Zip Code:47802-4315
Practice Address - Country:US
Practice Address - Phone:812-917-4629
Practice Address - Fax:812-917-4631
Is Sole Proprietor?:No
Enumeration Date:2012-08-05
Last Update Date:2018-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INF1212177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily