MEDICARE: MS. MONICA V TAGLE RNC, MSN, CPNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0200X	Pediatric Nurse Practitioner	608549	TX
2	363LP0200X	Pediatric Nurse Practitioner	AP111865	TX

General Provider Information

NPI Number	:	1629072483
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MONICA V TAGLE RNC, MSN, CPNP

Provider Business Mailing Address
First Line	:	6418 ECKHERT RD APT 12219
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-3059
Country	:	US
Telephone Number	:	210-685-1054
Fax Number	:

Provider Business Practice Location Address
First Line	:	24200 IH 10 W STE 108
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78257-1150
Country	:	US
Telephone Number	:	210-263-9443
Fax Number	:	726-999-2625

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	11/29/2022

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