Healthcare Provider Details

I. General information

NPI: 1093344400
Provider Name (Legal Business Name): VICTORINE TEBONG FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2020
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 N HIGHWAY 67 STE 5B
CEDAR HILL TX
75104-2156
US

IV. Provider business mailing address

5928 SUMMERWOOD DR
GRAND PRAIRIE TX
75052-0436
US

V. Phone/Fax

Practice location:
  • Phone: 972-408-6653
  • Fax: 214-827-3671
Mailing address:
  • Phone: 972-408-6653
  • Fax: 214-827-3671

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP144678
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: