Individual
REXANNA TATLOCK
Active
Individual
REXANNA TATLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGPCNP-BC
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
28204653A
IN
363LA2200X
Adult Health Nurse Practitioner
Primary
71008415A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001214853
ANTHEM PROVIDER NUMBER
IN
05
—
300021975
—
IN
Enumeration date
07/17/2018
Last updated
06/25/2026
Update your record
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