Provider Demographics
NPI:1952157620
Name:OWENS, TAMMY (SUPERVISOR(OWNER))
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:SUPERVISOR(OWNER)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3253 HILLCREST DR APT 113
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201-7041
Mailing Address - Country:US
Mailing Address - Phone:210-380-0378
Mailing Address - Fax:
Practice Address - Street 1:8700 POST OAK LN
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5170
Practice Address - Country:US
Practice Address - Phone:210-591-8603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-24
Last Update Date:2024-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXNA0060056102376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide