Tackla, Jeanine Marie

Tackla, Jeanine Marie is an sole proprietor health care provider with primary practice located at 800 Medical Center Dr Ste C , Decatur TX 76234-3844. She recently has 2 registered licenses in different health care specialties including Nursing Service Providers / Registered Nurse First Assistant, Physician Assistants & Advanced Practice Nursing Providers / Gerontology. Physician Assistants & Advanced Practice Nursing Providers / Gerontology is her primary health care specialty. Tackla, Jeanine Marie can be contacted via phone (940) 626-2110.

Contact Information

Primary practice address
800 Medical Center Dr Ste C Decatur TX 76234-3844
Phone: (940) 626-2110
Fax: (940) 626-2113
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Providers / Registered Nurse First Assistant 163WR0006X 095692 Illinois
Physician Assistants & Advanced Practice Nursing Providers / Gerontology 363LG0600X 1114749 Texas

Profile Details

NPI number 1255612537
LBN Legal business name Tackla, Jeanine Marie
Credentials APRN, MSN, A-GNP-C,
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 31st, 2011
Last updated Sep 14th, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

Request for update

Identifiers

StateTypeNumberIssuer
All States NPI 1255612537 NPPES
Illinois Other 041214374 REGISTERED PROFESSIONAL NURSE
Illinois Other 95094533 REGISTERED PROFESSIONAL NURSE
Illinois Other 095692 REGISTERED PROFESSIONAL NURSE
Illinois Other 1114749 REGISTERED PROFESSIONAL NURSE
Illinois Other 915559 REGISTERED PROFESSIONAL NURSE

Popular Providers