MEDICARE: SHAMETRIA TANN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	1023532	TX

General Provider Information

NPI Number	:	1124615612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAMETRIA TANN

Provider Business Mailing Address
First Line	:	3003 TEXAS PKWY UNIT B
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489-5242
Country	:	US
Telephone Number	:	346-374-8402
Fax Number	:

Provider Business Practice Location Address
First Line	:	3003 TEXAS PKWY UNIT B
Second Line	:
City	:	MISSOURI CITY
State	:	TX
Zip	:	77489-5242
Country	:	US
Telephone Number	:	346-374-8402
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/30/2020
Last Update Date	:	12/30/2020

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Directions to “ SHAMETRIA TANN ” Practice Location

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