Healthcare Provider Details

I. General information

NPI: 1235005158
Provider Name (Legal Business Name): REBECCA MACALUSO NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1040 S FLEISHEL AVE
TYLER TX
75701-2031
US

IV. Provider business mailing address

1040 S FLEISHEL AVE
TYLER TX
75701-2031
US

V. Phone/Fax

Practice location:
  • Phone: 903-533-8702
  • Fax: 903-533-8720
Mailing address:
  • Phone: 903-533-8702
  • Fax: 903-533-8720

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1215341
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: