Provider Demographics
NPI:1598831745
Name:TODD, TAMERA ELAINE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:TAMERA
Middle Name:ELAINE
Last Name:TODD
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 1:207 NW 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:TX
Mailing Address - Zip Code:79360-3447
Mailing Address - Country:US
Mailing Address - Phone:432-758-4944
Mailing Address - Fax:432-758-4747
Practice Address - Street 1:207 NW 8TH ST
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:TX
Practice Address - Zip Code:79360-3447
Practice Address - Country:US
Practice Address - Phone:432-758-4944
Practice Address - Fax:432-758-4747
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-28
Last Update Date:2023-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX555315261Q00000X, 313M00000X
TXAP106614363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX018955701Medicaid