Provider Demographics
NPI:1518233519
Name:GARCIA, ANTONIO T (NP)
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:T
Last Name:GARCIA
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596
Mailing Address - Country:US
Mailing Address - Phone:956-647-8600
Mailing Address - Fax:956-969-9564
Practice Address - Street 1:1701 S CAGE BLVD STE 116
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6459
Practice Address - Country:US
Practice Address - Phone:956-702-7054
Practice Address - Fax:956-702-7054
Is Sole Proprietor?:No
Enumeration Date:2012-03-24
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117047363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX327643802Medicaid
TX327643802Medicaid