Provider Demographics
NPI:1811410608
Name:TALIANCICH, DESIREE G (FNP-C)
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:G
Last Name:TALIANCICH
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2640 WINDSOR PL
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-3987
Mailing Address - Country:US
Mailing Address - Phone:956-465-5694
Mailing Address - Fax:
Practice Address - Street 1:26 S CORIA ST STE B
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-7566
Practice Address - Country:US
Practice Address - Phone:956-546-4234
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1266207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine