Provider Demographics
NPI:1043599137
Name:COFFEY, TAMARAH K (RN, PNP)
Entity Type:Individual
Prefix:
First Name:TAMARAH
Middle Name:K
Last Name:COFFEY
Suffix:
Gender:F
Credentials:RN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 N LAURENT ST STE 410
Mailing Address - Street 2:
Mailing Address - City:VICTORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77901-5469
Mailing Address - Country:US
Mailing Address - Phone:361-572-0333
Mailing Address - Fax:361-703-5101
Practice Address - Street 1:2806 N NAVARRO ST STE B
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901-3937
Practice Address - Country:US
Practice Address - Phone:361-894-8745
Practice Address - Fax:361-894-8748
Is Sole Proprietor?:No
Enumeration Date:2011-08-08
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX643088363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX643088OtherPEDIATRIC NURSE PRACTITIONER