Provider Demographics
NPI:1104832518
Name:ETIENNE, JUSTINA (DNP, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JUSTINA
Middle Name:
Last Name:ETIENNE
Suffix:
Gender:F
Credentials:DNP, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7401 N 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-1843
Mailing Address - Country:US
Mailing Address - Phone:832-969-4349
Mailing Address - Fax:
Practice Address - Street 1:7401 N 4TH ST
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-1843
Practice Address - Country:US
Practice Address - Phone:566-187-1009
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2019-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX569795363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F3611Medicare PIN