Provider Demographics
NPI:1083499636
Name:MONTIERTH, PATRICIA ANDREA TAN (AGACNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:PATRICIA ANDREA
Middle Name:TAN
Last Name:MONTIERTH
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:PATRICIA ANDREA
Other - Middle Name:ADLER
Other - Last Name:TAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN-BC
Mailing Address - Street 1:100 MAJESTIC WAY
Mailing Address - Street 2:
Mailing Address - City:LIBERTY HILL
Mailing Address - State:TX
Mailing Address - Zip Code:78642-6415
Mailing Address - Country:US
Mailing Address - Phone:559-972-6183
Mailing Address - Fax:
Practice Address - Street 1:100 MAJESTIC WAY
Practice Address - Street 2:
Practice Address - City:LIBERTY HILL
Practice Address - State:TX
Practice Address - Zip Code:78642-6415
Practice Address - Country:US
Practice Address - Phone:559-972-6183
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-30
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1134398363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care