Provider Demographics
NPI:1578121638
Name:DELAND, TAMRA LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:TAMRA
Middle Name:LYNN
Last Name:DELAND
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 ZARLEY DR
Mailing Address - Street 2:
Mailing Address - City:COPPERAS COVE
Mailing Address - State:TX
Mailing Address - Zip Code:76522-1841
Mailing Address - Country:US
Mailing Address - Phone:254-290-3263
Mailing Address - Fax:
Practice Address - Street 1:206 S WALLACE CREEK RD
Practice Address - Street 2:
Practice Address - City:SAN SABA
Practice Address - State:TX
Practice Address - Zip Code:76877-9516
Practice Address - Country:US
Practice Address - Phone:325-372-4255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-04
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine