Provider Demographics
NPI:1306689286
Name:TOMASEVIC, PETAR (RN)
Entity type:Individual
Prefix:
First Name:PETAR
Middle Name:
Last Name:TOMASEVIC
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3468 MULBERRY CREEK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78732-2253
Mailing Address - Country:US
Mailing Address - Phone:347-738-2264
Mailing Address - Fax:
Practice Address - Street 1:3468 MULBERRY CREEK DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-2253
Practice Address - Country:US
Practice Address - Phone:347-738-2264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-17
Last Update Date:2024-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX948816163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse