Provider Demographics
NPI:1417629122
Name:TAVARES, ALBASSI DE LIMA (APRN)
Entity Type:Individual
Prefix:
First Name:ALBASSI
Middle Name:DE LIMA
Last Name:TAVARES
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6210 E HWY 290
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-1142
Mailing Address - Country:US
Mailing Address - Phone:512-483-8586
Mailing Address - Fax:512-406-6216
Practice Address - Street 1:1401 MEDICAL PKWY STE 220
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-5013
Practice Address - Country:US
Practice Address - Phone:512-260-1581
Practice Address - Fax:512-406-7309
Is Sole Proprietor?:No
Enumeration Date:2021-09-30
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1048230363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily