Provider Demographics
NPI:1588680425
Name:GUTIERREZ, THOMAS (RN, MSN, FNP)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:GUTIERREZ
Suffix:
Gender:M
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 MILLWOOD LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-6704
Mailing Address - Country:US
Mailing Address - Phone:210-710-4127
Mailing Address - Fax:
Practice Address - Street 1:1381 S. MAIN ST.
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006
Practice Address - Country:US
Practice Address - Phone:830-249-9424
Practice Address - Fax:830-249-9607
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX664008363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner