Provider Demographics
NPI:1790032167
Name:TATKON-COKER, ANDREA LAURA (APMHNP-BC)
Entity Type:Individual
Prefix:PROF
First Name:ANDREA
Middle Name:LAURA
Last Name:TATKON-COKER
Suffix:
Gender:F
Credentials:APMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 OAK DR
Mailing Address - Street 2:
Mailing Address - City:MASON CITY
Mailing Address - State:IA
Mailing Address - Zip Code:50401-2962
Mailing Address - Country:US
Mailing Address - Phone:641-423-2521
Mailing Address - Fax:
Practice Address - Street 1:37 OAK DR
Practice Address - Street 2:
Practice Address - City:MASON CITY
Practice Address - State:IA
Practice Address - Zip Code:50401-2962
Practice Address - Country:US
Practice Address - Phone:641-423-2521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-04
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAG-070675363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health