Healthcare Provider Details

I. General information

NPI: 1114153525
Provider Name (Legal Business Name): SHEILA E TACK APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2009
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5320 S RAINBOW BLVD STE 182
LAS VEGAS NV
89118-1896
US

IV. Provider business mailing address

6355 S BUFFALO DR FL 3
LAS VEGAS NV
89113-2133
US

V. Phone/Fax

Practice location:
  • Phone: 702-255-3547
  • Fax: 702-212-4993
Mailing address:
  • Phone: 702-216-3346
  • Fax: 702-921-2419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPRN001125
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: