Provider Demographics
NPI:1134604457
Name:GRAFFAGNINO, THOMAS REAGAN (FNP-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:REAGAN
Last Name:GRAFFAGNINO
Suffix:
Gender:M
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 1:1501 W CHURCH ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77351-0056
Mailing Address - Country:US
Mailing Address - Phone:936-327-0191
Mailing Address - Fax:
Practice Address - Street 1:1501 W CHURCH ST STE 800
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:TX
Practice Address - Zip Code:77351-0056
Practice Address - Country:US
Practice Address - Phone:936-327-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-02
Last Update Date:2024-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139031363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily