Healthcare Provider Details

I. General information

NPI: 1457604316
Provider Name (Legal Business Name): MARISA J. TABALNO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARISA J. MOE NP

II. Dates (important events)

Enumeration Date: 10/17/2012
Last Update Date: 08/29/2025
Certification Date: 08/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2204E JOE BATTLE BLVD
EL PASO TX
79938-4659
US

IV. Provider business mailing address

98-1079 MOANALUA RD STE 630
AIEA HI
96701-4721
US

V. Phone/Fax

Practice location:
  • Phone: 915-503-1870
  • Fax:
Mailing address:
  • Phone: 808-485-5414
  • Fax: 808-485-3022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN-2471
License Number StateHI
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1151757
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: