Healthcare Provider Details

I. General information

NPI: 1003798877
Provider Name (Legal Business Name): TOMMIE SALINAS CNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2025
Last Update Date: 07/23/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 CAMINO DE VIDA STE 300
SANTA ROSA NM
88435-2267
US

IV. Provider business mailing address

592 RIVER RD
SANTA ROSA NM
88435-2262
US

V. Phone/Fax

Practice location:
  • Phone: 575-472-4311
  • Fax:
Mailing address:
  • Phone: 575-781-7013
  • Fax: 575-781-7013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number84887
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: