Provider Demographics
NPI:1255188744
Name:BOGGAN, TAFFY (RNFA)
Entity type:Individual
Prefix:
First Name:TAFFY
Middle Name:
Last Name:BOGGAN
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5000 LONG PRAIRIE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2797
Mailing Address - Country:US
Mailing Address - Phone:972-420-1776
Mailing Address - Fax:
Practice Address - Street 1:5000 LONG PRAIRIE RD STE 100
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2797
Practice Address - Country:US
Practice Address - Phone:972-420-1776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-02
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX757894163WX0800X
TX1168111363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WX0800XNursing Service ProvidersRegistered NurseOrthopedic