Provider Demographics
NPI:1699100412
Name:TAMAYO, WANDA JEAN (NP)
Entity type:Individual
Prefix:
First Name:WANDA
Middle Name:JEAN
Last Name:TAMAYO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1719 BLUE CREST LN
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-5103
Mailing Address - Country:US
Mailing Address - Phone:210-452-7063
Mailing Address - Fax:
Practice Address - Street 1:11398 BANDERA RD STE 201
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78250-6827
Practice Address - Country:US
Practice Address - Phone:210-543-7334
Practice Address - Fax:210-314-5044
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX683610363LP0222X
TXAP124391363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LP0222XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics, Critical Care