Provider Demographics
NPI:1518249150
Name:GARZA, JOANN (PA-C)
Entity Type:Individual
Prefix:
First Name:JOANN
Middle Name:
Last Name:GARZA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 E BRAVO BLVD
Mailing Address - Street 2:
Mailing Address - City:ROMA
Mailing Address - State:TX
Mailing Address - Zip Code:78584-5720
Mailing Address - Country:US
Mailing Address - Phone:956-849-2176
Mailing Address - Fax:956-849-4155
Practice Address - Street 1:640 E BRAVO BLVD
Practice Address - Street 2:
Practice Address - City:ROMA
Practice Address - State:TX
Practice Address - Zip Code:78584-5720
Practice Address - Country:US
Practice Address - Phone:956-849-2176
Practice Address - Fax:956-849-4155
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA 01824363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1518249150Medicaid
TXTXB140871Medicare PIN