Provider Demographics
NPI:1093340697
Name:GOLDSMITH, AMBER TENILLE (FNP)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:TENILLE
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:175 CARLA ST
Mailing Address - Street 2:
Mailing Address - City:VIDOR
Mailing Address - State:TX
Mailing Address - Zip Code:77662-9184
Mailing Address - Country:US
Mailing Address - Phone:409-782-6733
Mailing Address - Fax:
Practice Address - Street 1:4347 PHELAN BLVD
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2159
Practice Address - Country:US
Practice Address - Phone:409-767-9285
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-04
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145373363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily