Provider Demographics
NPI:1861980195
Name:URBANO, THEODORE TAGLE (APRN)
Entity type:Individual
Prefix:MR
First Name:THEODORE
Middle Name:TAGLE
Last Name:URBANO
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 AIR FORCE PENTAGON RM 4A870
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20330-1760
Mailing Address - Country:US
Mailing Address - Phone:703-697-3255
Mailing Address - Fax:
Practice Address - Street 1:1760 AIR FORCE PENTAGON RM 4A870
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20330-1760
Practice Address - Country:US
Practice Address - Phone:703-697-3255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-23
Last Update Date:2023-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9329674163W00000X
VA0024188359364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163W00000XNursing Service ProvidersRegistered Nurse