Provider Demographics
NPI:1215043690
Name:LONGORIA, CHRISTIAN RENAE (RN, FNP)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:RENAE
Last Name:LONGORIA
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:45 NE LOOP 410
Mailing Address - Street 2:STE 850
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-5824
Mailing Address - Country:US
Mailing Address - Phone:210-805-9800
Mailing Address - Fax:210-805-8770
Practice Address - Street 1:555 E BASSE RD STE 117
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78209-8329
Practice Address - Country:US
Practice Address - Phone:210-546-1430
Practice Address - Fax:210-546-1439
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX606979363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2854499-01Medicaid
TX8G8269OtherMEDICARE PTAN