Provider Demographics
NPI:1457502023
Name:TUGUTA, ROSE UKUNDWA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ROSE
Middle Name:UKUNDWA
Last Name:TUGUTA
Suffix:
Gender:F
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 1:2959 S BUCKNER BLVD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75227-6945
Mailing Address - Country:US
Mailing Address - Phone:214-206-4974
Mailing Address - Fax:214-206-4979
Practice Address - Street 1:2959 S BUCKNER BLVD
Practice Address - Street 2:SUITE 700
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75227-6945
Practice Address - Country:US
Practice Address - Phone:214-206-4974
Practice Address - Fax:214-206-4979
Is Sole Proprietor?:No
Enumeration Date:2008-10-01
Last Update Date:2020-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP115290363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX321275YV7AMedicare PIN