Provider Demographics
NPI:1508485970
Name:BRICOUT, CHRISTINA (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:BRICOUT
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 1:15207 FALL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247-3222
Mailing Address - Country:US
Mailing Address - Phone:616-402-0963
Mailing Address - Fax:
Practice Address - Street 1:23119 W INTERSTATE 10 BLDG 9
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78257-1767
Practice Address - Country:US
Practice Address - Phone:210-972-8058
Practice Address - Fax:210-899-1613
Is Sole Proprietor?:No
Enumeration Date:2020-04-15
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1131025363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology