Provider Demographics
NPI:1992858575
Name:TANGUNAN, PRISCILLA LIZELLE HERNANDO (MD)
Entity Type:Individual
Prefix:DR
First Name:PRISCILLA
Middle Name:LIZELLE HERNANDO
Last Name:TANGUNAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1 MERCY LN
Mailing Address - Street 2:SUITE 301
Mailing Address - City:HOT SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71913-6442
Mailing Address - Country:US
Mailing Address - Phone:501-623-3388
Mailing Address - Fax:501-623-3899
Practice Address - Street 1:1 MERCY LN
Practice Address - Street 2:SUITE 301
Practice Address - City:HOT SPRINGS
Practice Address - State:AR
Practice Address - Zip Code:71913-6442
Practice Address - Country:US
Practice Address - Phone:501-623-3388
Practice Address - Fax:501-623-3899
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2008-02-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ARC-8539207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5J275Medicare PIN
ARF-71372Medicare UPIN