Provider Demographics
NPI:1477949808
Name:GROTTE, TAMRA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:TAMRA
Middle Name:
Last Name:GROTTE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 SCHOOL ST STE 30
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4595
Mailing Address - Country:US
Mailing Address - Phone:281-357-0747
Mailing Address - Fax:832-559-5190
Practice Address - Street 1:455 SCHOOL ST STE 30
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4595
Practice Address - Country:US
Practice Address - Phone:281-357-0747
Practice Address - Fax:832-559-5190
Is Sole Proprietor?:No
Enumeration Date:2015-04-13
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0612753163W00000X
TXAP113043363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX612753OtherNURSING LICENCE