Provider Demographics
NPI:1043676307
Name:DITTMAN, SEAN (APRN, FNP-C)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:
Last Name:DITTMAN
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:232 BRITE RD STE 117
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-3998
Mailing Address - Country:US
Mailing Address - Phone:210-247-2248
Mailing Address - Fax:210-368-6270
Practice Address - Street 1:232 BRITE RD STE 117
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-3998
Practice Address - Country:US
Practice Address - Phone:210-247-2248
Practice Address - Fax:210-368-6270
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-01
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP130293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX367644701Medicaid