Provider Demographics
NPI:1770351785
Name:TAMAYO GONZALEZ, GREYSI
Entity type:Individual
Prefix:
First Name:GREYSI
Middle Name:
Last Name:TAMAYO GONZALEZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21511 IH 35 STE 105
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-6683
Mailing Address - Country:US
Mailing Address - Phone:512-262-7307
Mailing Address - Fax:512-262-0049
Practice Address - Street 1:21511 IH 35 STE 105
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6683
Practice Address - Country:US
Practice Address - Phone:512-262-7307
Practice Address - Fax:512-262-0049
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1144661363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner