Provider Demographics
NPI:1477268829
Name:CLINTON, THERESA ADELAIDA (AGACNP-BC)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:ADELAIDA
Last Name:CLINTON
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2975
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78540-2975
Mailing Address - Country:US
Mailing Address - Phone:956-362-8170
Mailing Address - Fax:956-362-8168
Practice Address - Street 1:5501 S MCCOLL RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-5503
Practice Address - Country:US
Practice Address - Phone:956-362-8170
Practice Address - Fax:956-362-8168
Is Sole Proprietor?:No
Enumeration Date:2023-01-19
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1104871363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care