REXANNA TATLOCK (NPI# 1851877328) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1851877328 |
| Entity Type | Individual |
| Full Name | REXANNA TATLOCK |
| Credential | AGPCNP-BC |
| Practice Address |
1116 N 16th St Ste A Lafayette IN 47904-2119 |
| Mailing Address |
Po Box 5545 Lafayette IN 47903-5545 |
| Practice Telephone | 7654488000 |
| Practice Fax Number | 7658384334 |
| Mailing Telephone | 7654488000 |
| Mailing Fax Number | 7654488085 |
| Enumeration Date | 2018-07-17 |
| Last Update Date | 2019-02-18 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163W00000X | Registered Nurse | 28204653A | IN | Nursing Service Providers |
| Y | 363LA2200X |
Nurse Practitioner Specialization: Adult Health |
71008415A | IN | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 300021975 | 05 | |
| IN | ANTHEM PROVIDER NUMBER | 000001214853 | 01 |
| Street Address |
1116 N 16TH ST STE A |
| City | LAFAYETTE |
| State | IN |
| Zip Code | 47904-2119 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174519466 | Michael Jay Scott Sheridan | Thoracic Surgery (Cardiothoracic Vascular Surgery) | 1116 N 16th St Ste A, Lafayette, IN 47904 | 2005-09-22 |
| 1346686235 | Theodore E. Vancott | Registered Nurse | 1116 N 16th St Ste A, Lafayette, IN 47904-2119 | 2013-05-17 |
| 1871792770 | Sirumugai M Saravanan | Internal Medicine | 1116 N 16th St Ste A, Lafayette, IN 47904-2119 | 2007-07-12 |
| 1568526432 | Arnett Clinic, LLC | Durable Medical Equipment & Medical Supplies | 1116 N 16th St Ste A, Lafayette, IN 47904-2119 | 2006-12-21 |
| 1144253170 | Igor Tubin | Internal Medicine | 1116 N 16th St Ste A, Lafayette, IN 47904-2119 | 2006-07-10 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568998615 | Angela Hands | Physical Therapy Assistant | 1260 North 17th Street, Lafayette, IN 47904 | 2017-05-11 |
| 1366894164 | Kathryn Barnett | Behavioral Analyst | 2785 Cason St # 2, Lafayette, IN 47904 | 2016-07-06 |
| 1881972917 | Rest Assured, LLC | Durable Medical Equipment & Medical Supplies | 180 Professional Ct., Lafayette, IN 47904 | 2011-07-22 |
| 1144514233 | Michelle Cristin Singleton | Dietitian, Registered | 508 N 26th St, Lafayette, IN 47904 | 2011-06-06 |
| 1912134438 | Jean D Trammel | Marriage & Family Therapist | 2000 Greenburg St, Bldg B, Suite A, Lafayette, IN 47904 | 2009-06-11 |
| 1902946056 | Terry Richard Baker | Optometrist | 2300 Sagamore Parkway S, Lafayette, IN 47904 | 2007-02-07 |
| 1891862165 | Becki A Bowditch Inc | Social Worker | 2201 Ferry Street, Lafayette, IN 47904 | 2006-11-29 |
| 1326121849 | James Lowell Thomas | Pediatrics | 2300 Ferry St, Lafayette, IN 47904 | 2006-10-21 |
| 1700976719 | Michael Leonard Bagnoli | Dentist | 2020 Union Street, Suite 200, Lafayette, IN 47904 | 2006-10-13 |
| 1255428801 | Lynn Arlen Pestle | Dentist | 2550 Elmwood Avenue, Lafayette, IN 47904 | 2006-10-06 |
| Find all providers in zip 47904 | ||||
| Taxonomy Code | 363LA2200X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Adult Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285182550 | Elizabeth Anne Summerhayes | Nurse Practitioner | 3542 Oconner Dr, Lafayette, CA 94549-4933 | 2016-09-15 |
| 1194106674 | Jessica J. Meredith | Nurse Practitioner | 4118 Trees Dr, Lafayette, IN 47909-3450 | 2015-06-10 |
| 1013291350 | Shelly Sebastien Richard | Nurse Practitioner | 501 W Saint Mary Blvd Ste 200, Lafayette, LA 70506-4665 | 2011-10-05 |
| 1134442692 | Christine Devillier Richard | Nurse Practitioner | 522 Harrell Dr, Lafayette, LA 70503-4935 | 2010-03-11 |
| 1679761761 | Grace Ihsiu Todd | Nurse Practitioner | 964 Mezzanine Dr, Planned Parenthood of Indiana and Kentucky, Lafayette, IN 47905-8631 | 2007-10-15 |
| 1396761060 | Deirdre Irene Detraz | Nurse Practitioner | 2801 Kaliste Saloom Rd, Suite 200 B, Lafayette, LA 70508-7181 | 2006-07-14 |
| 1861451106 | Anne Elizabeth Zahnke | Nurse Practitioner | 1 W 240 S, Lafayette, IN 47909-6303 | 2006-03-23 |
| 1194728568 | Gilbert Almanza | Nurse Practitioner | 1345 Unity Pl, Suite 345, Lafayette, IN 47905-5760 | 2005-05-31 |
| 1891330726 | Sarah Roth | Nurse Practitioner | 3750 Landmark Dr Ste B, Lafayette, IN 47905-6652 | 2019-11-14 |
| 1235774431 | Rdd Consulting | Nurse Practitioner | 3400 Moss St Ste B, Lafayette, LA 70507-6114 | 2019-11-12 |
| Find all providers in LAFAYETTE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.