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General NPI Number Information
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NPI Number | 1073746632
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Entity Type | Individual
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Provider Name | AMANDA LOUISE TAM PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/31/2009
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Last Update Date | 07/09/2021
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Provider Practice Location Address
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Address Line | 1920 CORPORATE DR STE 208
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City | SAN MARCOS
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State | TX
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Zip | 78666-6286
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Country | US
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Telephone | 512-878-6330
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Fax | 512-878-6941
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Provider Business Mailing Address
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Address Line | 1920 CORPORATE DR STE 208
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City | SAN MARCOS
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State | TX
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Zip | 78666-6286
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Country | US
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Telephone | 512-878-6330
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Fax | 512-878-6941
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 002020
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License Number State | IA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA12794
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License Number State | TX
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