Provider Demographics
NPI:1619350378
Name:LANGFORD, MARISSA GARCIA (NP)
Entity Type:Individual
Prefix:
First Name:MARISSA
Middle Name:GARCIA
Last Name:LANGFORD
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:PO BOX 1176
Mailing Address - Street 2:
Mailing Address - City:WALLER
Mailing Address - State:TX
Mailing Address - Zip Code:77484-1176
Mailing Address - Country:US
Mailing Address - Phone:936-931-3448
Mailing Address - Fax:
Practice Address - Street 1:13523 HARGRAVE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-3829
Practice Address - Country:US
Practice Address - Phone:281-206-4496
Practice Address - Fax:281-206-4487
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140443363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner