Provider Demographics
NPI:1407312705
Name:PENLAND, TERE (APRN, CPNP-PC)
Entity Type:Individual
Prefix:MRS
First Name:TERE
Middle Name:
Last Name:PENLAND
Suffix:
Gender:F
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 TREBLE KNL
Mailing Address - Street 2:
Mailing Address - City:SPRING BRANCH
Mailing Address - State:TX
Mailing Address - Zip Code:78070-6527
Mailing Address - Country:US
Mailing Address - Phone:210-415-6916
Mailing Address - Fax:
Practice Address - Street 1:4499 MEDICAL DR STE 280
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-3721
Practice Address - Country:US
Practice Address - Phone:210-614-4499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-02-12
Last Update Date:2022-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1089699363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics