Rafaelle W Tkac

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

1111882 Issued in TX

Practice address

1507 W Bay Area Blvd Ste 116
Webster, TX 77598-3404

Phone

(346) 617-8993

NPI assigned

Aug 30, 2018

Last updated

Dec 7, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Nurse Practitioner

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: rafaelle.tkac.1@8042.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Privia Medical Group Gulf Coast, PLLC

  • Obstetrics & Gynecology Physician
  • Houston, TX
  • NPI 1578969465
  Medicare reassignment NPD
• Privia Medical Group Gulf Coast PLLC

  dba Express Pain and Urgent Care

  • Interventional Pain Medicine Physician
  • San Antonio, TX
  • NPI 1457167033
  NPD
• Androderm X LLC

  • Primary Care Clinic/Center
  • Webster, TX
  • NPI 1760192017
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1535587200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733529600000",
    "number": "1801378310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1507 W BAY AREA BLVD STE 116",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775983404",
            "telephone_number": "346-617-8993"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1507 W BAY AREA BLVD STE 116",
            "city": "WEBSTER",
            "state": "TX",
            "postal_code": "775983404",
            "telephone_number": "346-617-8993"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "676 Fm 517 Rd W",
            "address_purpose": "LOCATION",
            "city": "Dickinson",
            "state": "TX",
            "postal_code": "775393904",
            "country_code": "US",
            "telephone_number": "409-572-2535",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TKAC",
        "first_name": "RAFAELLE",
        "middle_name": "W",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-08-30",
        "last_updated": "2024-12-07",
        "certification_date": "2024-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "TX",
            "license": "1111882",
            "primary": true
        },
        {
            "code": "163WP0200X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Pediatrics",
            "state": "TX",
            "license": "940461",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shanna Catherine Thompson, FNP-C
• Wayne Tie, M.D.
• Kerstin Timpone
• Shawn Marie Tippitt, WHNP-BC
• Titan EMS, LLC
• TMC Orthopedic, LP (TMC Orthopedic, LP - Clearlake)
• Nancy Tramanh To, DC
• Beatriz Leonor Tobon-Randal, MD
• Today's Vision Bay Area, PC (Today's Vision Baybrook)
• Today's Vision Baybrook Associates PA

• Nurse Practitioner in Webster, TX
• Providers in Webster, TX by specialty
• Nurse Practitioner in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.