Provider Demographics
NPI:1417722364
Name:TOSAW, ALYSSA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ALYSSA
Middle Name:
Last Name:TOSAW
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 ROBERTS CUT OFF RD
Mailing Address - Street 2:
Mailing Address - City:RIVER OAKS
Mailing Address - State:TX
Mailing Address - Zip Code:76114-2814
Mailing Address - Country:US
Mailing Address - Phone:817-713-6614
Mailing Address - Fax:
Practice Address - Street 1:1011 ROBERTS CUT OFF RD
Practice Address - Street 2:
Practice Address - City:RIVER OAKS
Practice Address - State:TX
Practice Address - Zip Code:76114-2814
Practice Address - Country:US
Practice Address - Phone:817-626-9744
Practice Address - Fax:817-626-9962
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-21
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1141655363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty