Provider Demographics
NPI:1437252236
Name:DITTBURNER, TAMI TERESE (ANP-BC)
Entity Type:Individual
Prefix:
First Name:TAMI
Middle Name:TERESE
Last Name:DITTBURNER
Suffix:
Gender:F
Credentials:ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:617 E LOOP 499
Mailing Address - Street 2:SUITE C
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-2477
Mailing Address - Country:US
Mailing Address - Phone:956-428-8264
Mailing Address - Fax:956-425-3642
Practice Address - Street 1:617 E LOOP 499
Practice Address - Street 2:SUITE C
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-2477
Practice Address - Country:US
Practice Address - Phone:956-428-8264
Practice Address - Fax:956-425-3642
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX520212363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXB165562OtherPTAN
TXB165562OtherPTAN
TXQ43654Medicare UPIN