Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Ephraim Tata Fombo, PMHNP-BC

Individual provider Registered Nurse · NPI 1134368327

Mr. Ephraim Tata Fombo, PMHNP-BC is a Nurse Practitioner in San Antonio, Texas. Qualified in 2016, 10 years ago. Practices as a sole proprietor and accepts Medicare assignment. Licensed in Ohio and Texas.

Years since qualifying
10
Licensed in
OH, TX
In the registry since
2009
Specialties on file
3
What do these letters mean?
PMHNP-BC — Psychiatric-Mental Health Nurse Practitioner, Board Certified
A board-certified psychiatric nurse practitioner.

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Practice location Address checks out

3031 W Ih 10 Attn: Credentialing Dept
San Antonio, TX 78201-5159
Phone: (210) 261-1000
Fax: (210) 731-8678
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence RN796897 (TX)
Registered Nurse Taxonomy 163W00000X · Licence RN 330129 (OH)
Registered Nurse Taxonomy 163W00000X · Licence 796897 (TX)

Record details

NPI number1134368327
Entity typeIndividual (Type 1)
GenderMale
Credentials PMHNP-BC
Sole proprietorYes
NPI enumeratedFebruary 11, 2009
Last updated in NPPESNovember 8, 2016

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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