Healthcare Provider Details

I. General information

NPI: 1558999706
Provider Name (Legal Business Name): ANNABELL TAGOE MSN, APRN, AGNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2020
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

544 PLEASANT ST
PAWTUCKET RI
02860-5726
US

IV. Provider business mailing address

451 ANDOVER ST
NORTH ANDOVER MA
01845-5044
US

V. Phone/Fax

Practice location:
  • Phone: 978-794-2000
  • Fax: 978-794-2007
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN02325
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAPRN02325
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN02325
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: