Provider Demographics
NPI:1508514019
Name:SERRANO, TESSA (APRN)
Entity Type:Individual
Prefix:
First Name:TESSA
Middle Name:
Last Name:SERRANO
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:TESSA
Other - Middle Name:J
Other - Last Name:SERRANO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:APRN
Mailing Address - Street 1:5015 FIERY SKY RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1843
Mailing Address - Country:US
Mailing Address - Phone:702-956-3191
Mailing Address - Fax:
Practice Address - Street 1:5015 FIERY SKY RIDGE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-1843
Practice Address - Country:US
Practice Address - Phone:702-956-3191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-14
Last Update Date:2022-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV852093363LA2200X, 363LG0600X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology