Provider Demographics
NPI:1245542976
Name:TANJUAKIO, ALEXANDER M (FNP-BC)
Entity type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:M
Last Name:TANJUAKIO
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10605 LANSDOWNE LN
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75089-8388
Mailing Address - Country:US
Mailing Address - Phone:214-577-5016
Mailing Address - Fax:972-463-6523
Practice Address - Street 1:3100 MCKINNON ST
Practice Address - Street 2:SUITE 400
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75201-1044
Practice Address - Country:US
Practice Address - Phone:214-754-8700
Practice Address - Fax:214-239-3769
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-10
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX701513363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily