Provider Demographics
NPI:1215040423
Name:D'AMICO, TONI M (PA)
Entity Type:Individual
Prefix:
First Name:TONI
Middle Name:M
Last Name:D'AMICO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 LOOP 337
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-8504
Mailing Address - Country:US
Mailing Address - Phone:830-609-0080
Mailing Address - Fax:830-629-0416
Practice Address - Street 1:2728 LOOP 337
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-8504
Practice Address - Country:US
Practice Address - Phone:830-609-0080
Practice Address - Fax:830-629-0416
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01953363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87N867OtherBCBS
TXTXB166707OtherWELLMED MEDICARE
TX192471403Medicaid
TX1924714-05OtherWELLMED MEDICAID
TXTXB166707OtherWELLMED MEDICARE