Healthcare Provider Details

I. General information

NPI: 1174122824
Provider Name (Legal Business Name): ANNA SPATARO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2020
Last Update Date: 10/23/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5200 HARRY HINES BLVD
DALLAS TX
75235-7709
US

IV. Provider business mailing address

5200 HARRY HINES BLVD
DALLAS TX
75235-7709
US

V. Phone/Fax

Practice location:
  • Phone: 469-419-0365
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number1015903
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: