Provider Demographics
NPI:1427359975
Name:TREVINO, TAMMY LYNN (RN, BSN, ACNP)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:TREVINO
Suffix:
Gender:F
Credentials:RN, BSN, ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 E SAUNDERS ST STE B290
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-5530
Mailing Address - Country:US
Mailing Address - Phone:956-794-8880
Mailing Address - Fax:956-794-8882
Practice Address - Street 1:1710 E SAUNDERS ST STE B290
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-5530
Practice Address - Country:US
Practice Address - Phone:956-794-8880
Practice Address - Fax:956-794-8882
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-15
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX715719363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care