Healthcare Provider Details

I. General information

NPI: 1063802007
Provider Name (Legal Business Name): TAMMY NEWCOMER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2015
Last Update Date: 04/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4502 MEDICAL DR
SAN ANTONIO TX
78229-4402
US

IV. Provider business mailing address

PO BOX 72090
PHOENIX AZ
85050-1019
US

V. Phone/Fax

Practice location:
  • Phone: 210-358-4000
  • Fax: 210-358-0647
Mailing address:
  • Phone: 480-361-7680
  • Fax: 480-361-7683

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP127345
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: