Provider Demographics
NPI:1588684047
Name:TIJERINA, JANE (NP)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:TIJERINA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:811 E AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:PARIS
Mailing Address - State:TX
Mailing Address - Zip Code:75460-7353
Mailing Address - Country:US
Mailing Address - Phone:903-785-0338
Mailing Address - Fax:903-785-5369
Practice Address - Street 1:811 E AUSTIN ST
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-7353
Practice Address - Country:US
Practice Address - Phone:903-785-0338
Practice Address - Fax:903-785-5369
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX443706363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX062643403Medicaid
TX0005330328OtherAETNA HEALTHCARE
TX8N8263OtherBLUE CROSS BLUE SHIELD OF TEXAS
TXP00398109OtherRAILROAD MEDICARE
TXP00398109OtherRAILROAD MEDICARE
TXS69086Medicare UPIN