Provider Demographics
NPI:1093471534
Name:TELLEZ, TAMIKA (NP)
Entity type:Individual
Prefix:
First Name:TAMIKA
Middle Name:
Last Name:TELLEZ
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 1:5484 COUNTY ROAD 75
Mailing Address - Street 2:
Mailing Address - City:ROBSTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78380-6031
Mailing Address - Country:US
Mailing Address - Phone:361-244-8338
Mailing Address - Fax:
Practice Address - Street 1:5484 COUNTY ROAD 75
Practice Address - Street 2:
Practice Address - City:ROBSTOWN
Practice Address - State:TX
Practice Address - Zip Code:78380-6031
Practice Address - Country:US
Practice Address - Phone:361-244-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-09
Last Update Date:2025-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95012533363LA2100X
TX141648363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty