Provider Demographics
NPI:1609805753
Name:TIJERINA, PATRICIA M (WHNP, LPA)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:M
Last Name:TIJERINA
Suffix:
Gender:F
Credentials:WHNP, LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 PAPPAS ST.
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-1705
Mailing Address - Country:US
Mailing Address - Phone:956-523-3642
Mailing Address - Fax:956-795-8135
Practice Address - Street 1:1515 PAPPAS ST.
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78040-1705
Practice Address - Country:US
Practice Address - Phone:956-523-3642
Practice Address - Fax:956-718-6294
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2012-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX517474363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102265903Medicaid