Provider Demographics
NPI:1508478348
Name:PINA, PRISCILLA (APRN)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:PINA
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 1:13450 EVERINGHAM ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-6603
Mailing Address - Country:US
Mailing Address - Phone:915-258-5228
Mailing Address - Fax:
Practice Address - Street 1:3270 JOE BATTLE BLVD STE 380
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79938-2649
Practice Address - Country:US
Practice Address - Phone:915-249-4344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-22
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145953363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care