Provider Demographics
NPI:1891317533
Name:CORDOVA, TRIANNA ILISE (FNP-C)
Entity Type:Individual
Prefix:
First Name:TRIANNA
Middle Name:ILISE
Last Name:CORDOVA
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 1:8611 BRYER CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-4859
Mailing Address - Country:US
Mailing Address - Phone:512-698-2179
Mailing Address - Fax:
Practice Address - Street 1:1717 SCOTTSDALE DR STE 120
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78641-4340
Practice Address - Country:US
Practice Address - Phone:512-489-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-16
Last Update Date:2020-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142858363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner