Healthcare Provider Details

I. General information

NPI: 1861980195
Provider Name (Legal Business Name): THEODORE TAGLE URBANO APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2018
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TWINING ST # 760
MONTGOMERY AL
36112-6027
US

IV. Provider business mailing address

300 TWINING ST # 760
MONTGOMERY AL
36112-6027
US

V. Phone/Fax

Practice location:
  • Phone: 334-953-3368
  • Fax:
Mailing address:
  • Phone: 334-953-3368
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number0024188359
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberAPRN11025406
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN9329674
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: