Provider Demographics
NPI:1174899330
Name:TAGLE, MARISSA YVETTE (PA-C)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:YVETTE
Last Name:TAGLE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2215 W FERN AVE STE B
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-6177
Mailing Address - Country:US
Mailing Address - Phone:956-540-5181
Mailing Address - Fax:956-468-2079
Practice Address - Street 1:2215 W FERN AVE STE B
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-6177
Practice Address - Country:US
Practice Address - Phone:956-540-5181
Practice Address - Fax:956-468-2079
Is Sole Proprietor?:No
Enumeration Date:2012-03-31
Last Update Date:2025-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07755363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant