Provider Demographics
NPI:1255677597
Name:TAGLE, JAMES ANTHONY JR (ACNP)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:ANTHONY
Last Name:TAGLE
Suffix:JR
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3540 E BROAD ST STE 120-141
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-5633
Mailing Address - Country:US
Mailing Address - Phone:915-887-1740
Mailing Address - Fax:682-227-2918
Practice Address - Street 1:3540 E BROAD ST STE 120-141
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-5633
Practice Address - Country:US
Practice Address - Phone:915-887-1740
Practice Address - Fax:682-227-2918
Is Sole Proprietor?:No
Enumeration Date:2012-12-13
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX675960363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care