Provider Demographics
NPI:1508460908
Name:TREVINO, BRICIA ELENA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BRICIA
Middle Name:ELENA
Last Name:TREVINO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5312 RIO BRAVO DR STE 10
Mailing Address - Street 2:
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008-9210
Mailing Address - Country:US
Mailing Address - Phone:575-915-1338
Mailing Address - Fax:575-915-1819
Practice Address - Street 1:5312 RIO BRAVO DR STE 10
Practice Address - Street 2:
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9210
Practice Address - Country:US
Practice Address - Phone:575-915-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-25
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1020325363L00000X
NM63216363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner