Healthcare Provider Details

I. General information

NPI: 1720522519
Provider Name (Legal Business Name): TAMIKA MICHELLE SCOTT FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/13/2016
Last Update Date: 12/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 UNIVERSITY BLVD
GALVESTON TX
77555-0527
US

IV. Provider business mailing address

1216 18TH AVE N
TEXAS CITY TX
77590-5659
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-0504
  • Fax: 409-772-5611
Mailing address:
  • Phone: 409-692-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP132431
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: