Provider Demographics
NPI:1730652439
Name:LEIBEL, PRISCILLA (NP-C)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:LEIBEL
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:PRISCILLA
Other - Middle Name:E
Other - Last Name:RUBIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:PO BOX 35629
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75235-0629
Mailing Address - Country:US
Mailing Address - Phone:214-424-2200
Mailing Address - Fax:214-231-2159
Practice Address - Street 1:855 PROTON RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4203
Practice Address - Country:US
Practice Address - Phone:210-614-1234
Practice Address - Fax:210-614-0952
Is Sole Proprietor?:No
Enumeration Date:2019-01-04
Last Update Date:2022-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139347363L00000X, 363LF0000X
TNAP139347363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily