Provider Demographics
NPI:1861149486
Name:TOMASSON, BRENDA (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:TOMASSON
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16306 BUENA TIERRA ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232-2542
Mailing Address - Country:US
Mailing Address - Phone:210-602-1605
Mailing Address - Fax:
Practice Address - Street 1:16306 BUENA TIERRA ST
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2542
Practice Address - Country:US
Practice Address - Phone:210-602-1605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-03
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1058629363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1058629OtherTEXAS BOARD OF NURSING