Provider Demographics
NPI:1962803841
Name:RODRIGUEZ, TAMARA (FNP-C)
Entity type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:RODRIGUEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 W GOODWIN ST
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-4115
Mailing Address - Country:US
Mailing Address - Phone:830-570-9420
Mailing Address - Fax:830-769-5913
Practice Address - Street 1:1907 HIGHWAY 97 E
Practice Address - Street 2:SUITE 280
Practice Address - City:JOURDANTON
Practice Address - State:TX
Practice Address - Zip Code:78026-1537
Practice Address - Country:US
Practice Address - Phone:830-769-5912
Practice Address - Fax:830-769-5913
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126022363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner