Provider Demographics
NPI:1275396772
Name:CAUBLE, TAMARA DENISE (AGACNP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:DENISE
Last Name:CAUBLE
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1201 FAIRMOUNT AVE
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-4215
Mailing Address - Country:US
Mailing Address - Phone:817-335-5288
Mailing Address - Fax:817-338-0927
Practice Address - Street 1:1201 FAIRMOUNT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4215
Practice Address - Country:US
Practice Address - Phone:817-335-5288
Practice Address - Fax:817-338-0927
Is Sole Proprietor?:No
Enumeration Date:2024-02-06
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX8631359363L00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner