Provider Demographics
NPI:1467876664
Name:ISAZA, ADRIANA (APRN)
Entity Type:Individual
Prefix:
First Name:ADRIANA
Middle Name:
Last Name:ISAZA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 E TIDWELL RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77022-1822
Mailing Address - Country:US
Mailing Address - Phone:713-691-0035
Mailing Address - Fax:713-691-2448
Practice Address - Street 1:720 E TIDWELL RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77022-1822
Practice Address - Country:US
Practice Address - Phone:713-691-0035
Practice Address - Fax:713-691-2448
Is Sole Proprietor?:No
Enumeration Date:2014-02-07
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX695985363LA2200X
TXAP125058363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1467876664Medicaid