Provider Demographics
NPI:1073027082
Name:MCNEAL-IBIKUNLE, TAMMIE VALTINA (FNP-C)
Entity Type:Individual
Prefix:
First Name:TAMMIE
Middle Name:VALTINA
Last Name:MCNEAL-IBIKUNLE
Suffix:
Gender:F
Credentials: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:TOWN CENTER PHYSICIANS
Mailing Address - Street 2:4780 SWEETWATER BLVD #100
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479
Mailing Address - Country:US
Mailing Address - Phone:281-491-0094
Mailing Address - Fax:832-532-4072
Practice Address - Street 1:TOWN CENTER PHYSICIANS
Practice Address - Street 2:4780 SWEETWATER BLVD #100
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479
Practice Address - Country:US
Practice Address - Phone:281-491-0094
Practice Address - Fax:832-532-4072
Is Sole Proprietor?:No
Enumeration Date:2017-11-29
Last Update Date:2020-03-03
Deactivation Date:2020-02-25
Deactivation Code:
Reactivation Date:2020-03-03
Provider Licenses
StateLicense IDTaxonomies
TXAP135874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily