Provider Demographics
NPI:1700362647
Name:TEBBS, MARK ALLAN (LVN)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLAN
Last Name:TEBBS
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 CORIANDER BND
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-5471
Mailing Address - Country:US
Mailing Address - Phone:210-771-1234
Mailing Address - Fax:
Practice Address - Street 1:310 CORIANDER BND
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-5471
Practice Address - Country:US
Practice Address - Phone:210-771-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-13
Last Update Date:2018-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153404164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse