Provider Demographics
NPI:1164572392
Name:TADESSE, TSEDEY ABERRA (APRN, BC)
Entity Type:Individual
Prefix:
First Name:TSEDEY
Middle Name:ABERRA
Last Name:TADESSE
Suffix:
Gender:F
Credentials:APRN, BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3217 BREWTON DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75074-8764
Mailing Address - Country:US
Mailing Address - Phone:832-724-3946
Mailing Address - Fax:
Practice Address - Street 1:1121 W MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4435
Practice Address - Country:US
Practice Address - Phone:817-454-9840
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX635473363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health