Provider Demographics
NPI:1710051115
Name:GOLDMAN, TINA L (MSN, RN, CPNP)
Entity Type:Individual
Prefix:MRS
First Name:TINA
Middle Name:L
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MSN, RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 STEPHENS PL STE 100
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-2151
Mailing Address - Country:US
Mailing Address - Phone:830-627-9878
Mailing Address - Fax:
Practice Address - Street 1:2115 STEPHENS PL STE 100
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2151
Practice Address - Country:US
Practice Address - Phone:830-627-9878
Practice Address - Fax:830-627-9879
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2021-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111845363LP0200X
TX624888363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1710051115Medicaid