Provider Demographics
NPI:1558835173
Name:TESFAY, ANDE TEWOLDE (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:
First Name:ANDE
Middle Name:TEWOLDE
Last Name:TESFAY
Suffix:
Gender:M
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13419 SARENTO VLG # 314
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-2270
Mailing Address - Country:US
Mailing Address - Phone:415-568-8230
Mailing Address - Fax:
Practice Address - Street 1:13419 SARENTO VLG
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77498-2270
Practice Address - Country:US
Practice Address - Phone:415-568-8230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-16
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139951363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXNONEOtherNONE