Provider Demographics
NPI:1518540988
Name:BRIONES, ERMINIA MARGARITA (PTA)
Entity Type:Individual
Prefix:
First Name:ERMINIA
Middle Name:MARGARITA
Last Name:BRIONES
Suffix:
Gender:F
Credentials:PTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 N GAINES AVE
Mailing Address - Street 2:
Mailing Address - City:TULIA
Mailing Address - State:TX
Mailing Address - Zip Code:79088-1113
Mailing Address - Country:US
Mailing Address - Phone:806-995-2180
Mailing Address - Fax:
Practice Address - Street 1:4120 22ND PL
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79410-1122
Practice Address - Country:US
Practice Address - Phone:806-793-3252
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-03
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2158901363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant