Provider Demographics
NPI:1568655579
Name:GARZA, GRISELDA ANNA (NP-C)
Entity Type:Individual
Prefix:
First Name:GRISELDA
Middle Name:ANNA
Last Name:GARZA
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 ROSS ST
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79103-2700
Mailing Address - Country:US
Mailing Address - Phone:806-374-7341
Mailing Address - Fax:806-322-0533
Practice Address - Street 1:125 W PARK AVE
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-4201
Practice Address - Country:US
Practice Address - Phone:806-364-7688
Practice Address - Fax:806-364-7694
Is Sole Proprietor?:No
Enumeration Date:2007-08-22
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8Y82306OtherBCBSTX
TX191188501Medicaid
TX8Y82306OtherBCBSTX