Healthcare Provider Details

I. General information

NPI: 1003821166
Provider Name (Legal Business Name): ELLEN B JATINEN NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2006
Last Update Date: 10/14/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6836 BEE CAVES RD BLDG. 3 STE. 150
AUSTIN TX
78746-5059
US

IV. Provider business mailing address

6836 BEE CAVES RD BLDG. 3 STE. 150
AUSTIN TX
78746-5059
US

V. Phone/Fax

Practice location:
  • Phone: 512-375-2555
  • Fax: 512-485-1053
Mailing address:
  • Phone: 512-375-2555
  • Fax: 512-485-1053

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAP110073
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: