Provider Demographics
NPI:1669739496
Name:TABANAO, HANNAH MAE (NP-C)
Entity type:Individual
Prefix:
First Name:HANNAH MAE
Middle Name:
Last Name:TABANAO
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2455 NE LOOP 410 STE 100
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5650
Mailing Address - Country:US
Mailing Address - Phone:210-599-6000
Mailing Address - Fax:210-657-5586
Practice Address - Street 1:2455 NE LOOP 410 STE 100
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5650
Practice Address - Country:US
Practice Address - Phone:210-599-6000
Practice Address - Fax:210-657-5586
Is Sole Proprietor?:No
Enumeration Date:2012-04-18
Last Update Date:2018-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134796363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health