MEDICARE: GLORIA JEANE TATSAPAUGH FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	302509	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063504934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLORIA JEANE TATSAPAUGH FNP

Provider Business Mailing Address
First Line	:	1037 MAIN ST
Second Line	:	CREDENTIALING DEPT.
City	:	PEEKSKILL
State	:	NY
Zip	:	10566-2913
Country	:	US
Telephone Number	:	914-734-8858
Fax Number	:	914-734-8786

Provider Business Practice Location Address
First Line	:	3174 ROUTE 22
Second Line	:	HUDSON RIVER HEALTHCARE, INC.
City	:	DOVER PLAINS
State	:	NY
Zip	:	12522-5924
Country	:	US
Telephone Number	:	845-877-4793
Fax Number	:	845-877-9212

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	01/19/2012

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