Provider Demographics
NPI:1225718265
Name:TPL DELIVERED LLC
Entity Type:Organization
Organization Name:TPL DELIVERED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:KORY
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:361-548-1610
Mailing Address - Street 1:1307 COAHUILA LOOP
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78045-6637
Mailing Address - Country:US
Mailing Address - Phone:361-548-1610
Mailing Address - Fax:956-568-0873
Practice Address - Street 1:1307 COAHUILA LOOP
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78045-6637
Practice Address - Country:US
Practice Address - Phone:361-548-1610
Practice Address - Fax:956-568-0873
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty