Provider Demographics
NPI:1649773706
Name:TIJERINA, NAKITA NICOLE (LVN)
Entity Type:Individual
Prefix:
First Name:NAKITA
Middle Name:NICOLE
Last Name:TIJERINA
Suffix:
Gender:F
Credentials:LVN
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 1673
Mailing Address - Street 2:
Mailing Address - City:PREMONT
Mailing Address - State:TX
Mailing Address - Zip Code:78375-1673
Mailing Address - Country:US
Mailing Address - Phone:361-474-3043
Mailing Address - Fax:
Practice Address - Street 1:500 N SHORELINE BLVD STE 700S
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78401-0399
Practice Address - Country:US
Practice Address - Phone:361-882-1003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-15
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX221104164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse