MEDICARE: ALEXANDREA D TAGLE MS, APRN, PMHNP-BC

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	163W00000X	Registered Nurse	1167266	TX
2	163W00000X	Registered Nurse	519418	OH
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	1167266	TX

General Provider Information

NPI Number	:	1134990609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEXANDREA D TAGLE MS, APRN, PMHNP-BC

Provider Business Mailing Address
First Line	:	8275 WALNUT HILL LN APT 534
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4609
Country	:	US
Telephone Number	:	254-548-2329
Fax Number	:

Provider Business Practice Location Address
First Line	:	8275 WALNUT HILL LN APT 534
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75231-4609
Country	:	US
Telephone Number	:	254-548-2329
Fax Number	:

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

Provider Enumeration Date	:	01/12/2024
Last Update Date	:	07/29/2024

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