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General NPI Number Information
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NPI Number | 1992858575
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Entity Type | Individual
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Provider Name | PRISCILLA LIZELLE HERNANDO TANGUNAN M.D.
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Gender | Female
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | 1 MERCY LN SUITE 301
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City | HOT SPRINGS
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State | AR
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Zip | 71913-6442
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Country | US
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Telephone | 501-623-3388
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Fax | 501-623-3899
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Provider Business Mailing Address
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Address Line | 1 MERCY LN SUITE 301
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City | HOT SPRINGS
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State | AR
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Zip | 71913-6442
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Country | US
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Telephone | 501-623-3388
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Fax | 501-623-3899
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | C-8539
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License Number State | AR
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