Individual
MS. JEANINE MARIE TACKLA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN, MSN, A-GNP-C,
Contact information
Practice address
8739 DAVIS BLVD STE 100, KELLER, TX 76248-0309
(817) 476-1226
Mailing address
8408 FORT UNION CT, FT WORTH, TX 76137-5754
(847) 224-9722
Taxonomy
Speciality
Code
Description
License number
State
163WR0006X
Registered Nurse First Assistant
095692
IL
363LG0600X
Gerontology Nurse Practitioner
Primary
1114749
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041214374
REGISTERED PROFESSIONAL NURSE
IL
01
—
095692
CNOR, CRNFA
—
01
—
1114749
APRN-CNP
TX
01
—
915559
REGISTERED PROFESSIONAL NURSE
TX
01
—
95094533
REGISTERED PROFESSIONAL NURSE
CA
Enumeration date
08/31/2011
Last updated
03/17/2026
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