Provider Demographics
NPI:1184728602
Name:ZIMMERMAN, RENEE (APN-C)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:F
Credentials:APN-C
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:GAMBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APN-C
Mailing Address - Street 1:P.O. BOX 889 119 S. ELLIS
Mailing Address - Street 2:FRONTERA HEALTHCARE NETWORK, INC. MENARD CLINIC
Mailing Address - City:MENARD
Mailing Address - State:TX
Mailing Address - Zip Code:76859-0889
Mailing Address - Country:US
Mailing Address - Phone:325-396-4612
Mailing Address - Fax:325-396-2055
Practice Address - Street 1:302 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BALLINGER
Practice Address - State:TX
Practice Address - Zip Code:76821-5034
Practice Address - Country:US
Practice Address - Phone:325-365-5737
Practice Address - Fax:325-365-2405
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX662078363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX662078OtherAPN LICENSE