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General NPI Number Information
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NPI Number | 1639640790
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Entity Type | Individual
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Provider Name | DIRKSEN J. TAGUIAM MSN, APN-C
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Gender | Male
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Dates
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Enumeration Date | 12/16/2018
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Last Update Date | 12/23/2019
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Provider Practice Location Address
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Address Line | 210 JACK MARTIN BLVD STE D-1
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City | BRICK
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State | NJ
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Zip | 08724-7771
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Country | US
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Telephone | 732-458-5854
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Fax | 732-458-8012
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Provider Business Mailing Address
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Address Line | 210 JACK MARTIN BLVD STE D-1
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City | BRICK
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State | NJ
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Zip | 08724-7771
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Country | US
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Telephone | 732-458-5854
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Fax | 732-458-8012
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 26NJ00885000
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License Number State | NJ
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