Provider Demographics
NPI:1164982047
Name:TIETZE, YOMARA (FNP)
Entity Type:Individual
Prefix:
First Name:YOMARA
Middle Name:
Last Name:TIETZE
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 1:310 W OAKLAWN RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-4033
Mailing Address - Country:US
Mailing Address - Phone:830-569-8940
Mailing Address - Fax:830-569-8320
Practice Address - Street 1:540 10TH ST STE 140
Practice Address - Street 2:
Practice Address - City:FLORESVILLE
Practice Address - State:TX
Practice Address - Zip Code:78114-3167
Practice Address - Country:US
Practice Address - Phone:830-393-9390
Practice Address - Fax:830-393-9399
Is Sole Proprietor?:No
Enumeration Date:2019-03-25
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139565363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily