Healthcare Provider Details

I. General information

NPI: 1265069553
Provider Name (Legal Business Name): VICTORIA TOVAR PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2020
Last Update Date: 02/27/2025
Certification Date: 02/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 6TH AVE STE 110
FORT WORTH TX
76104-4929
US

IV. Provider business mailing address

800 MEDICAL CENTER DR STE C
DECATUR TX
76234-3844
US

V. Phone/Fax

Practice location:
  • Phone: 817-912-8040
  • Fax:
Mailing address:
  • Phone: 940-626-2110
  • Fax: 940-626-2113

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17776
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: