Healthcare Provider Details

I. General information

NPI: 1063504934
Provider Name (Legal Business Name): GLORIA JEANE TATSAPAUGH FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 01/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3174 ROUTE 22 HUDSON RIVER HEALTHCARE, INC.
DOVER PLAINS NY
12522-5924
US

IV. Provider business mailing address

1037 MAIN ST CREDENTIALING DEPT.
PEEKSKILL NY
10566-2913
US

V. Phone/Fax

Practice location:
  • Phone: 845-877-4793
  • Fax: 845-877-9212
Mailing address:
  • Phone: 914-734-8858
  • Fax: 914-734-8786

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number302509
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: