Provider Demographics
NPI:1033632443
Name:AFCC-AFFINITY FAMILY CARE CLINIC
Entity Type:Organization
Organization Name:AFCC-AFFINITY FAMILY CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DITTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:210-247-2248
Mailing Address - Street 1:PO BOX 264
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-0264
Mailing Address - Country:US
Mailing Address - Phone:210-385-7494
Mailing Address - Fax:
Practice Address - Street 1:232 BRITE RD
Practice Address - Street 2:SUITE 117
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108
Practice Address - Country:US
Practice Address - Phone:210-247-2248
Practice Address - Fax:210-579-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-18
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty