Provider Demographics
NPI:1871136390
Name:SHAMBAUGH, TESSA (FNP-C)
Entity type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:SHAMBAUGH
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-1860
Mailing Address - Fax:680-885-1396
Practice Address - Street 1:750 8TH AVE FL 6
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2515
Practice Address - Country:US
Practice Address - Phone:682-303-0376
Practice Address - Fax:682-303-0377
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2021-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX723594363LF0000X
TXAP143422363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily