Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | AP140089 | TX |
NPI | 1003414525 |
---|---|
Provider Name | Abram Ambriz |
First Address | Tyler, TX 75701-5934 |
Second Address | Tyler, TX 75701-5934 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/10/2020 |
Last Update Date | 09/11/2020 |