Provider Demographics
NPI:1649883497
Name:HACK, TASHA NICOLE (APRN, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:TASHA
Middle Name:NICOLE
Last Name:HACK
Suffix:
Gender:F
Credentials:APRN, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 W 35TH ST BLDG 14
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1222
Mailing Address - Country:US
Mailing Address - Phone:812-781-9473
Mailing Address - Fax:
Practice Address - Street 1:2200 W 35TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1222
Practice Address - Country:US
Practice Address - Phone:812-781-9473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-30
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145578363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care