Provider Demographics
NPI:1982203675
Name:TREVINO, ILSE DEYANIRE (NP-C)
Entity Type:Individual
Prefix:
First Name:ILSE
Middle Name:DEYANIRE
Last Name:TREVINO
Suffix:
Gender:F
Credentials:NP-C
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 787
Mailing Address - Street 2:
Mailing Address - City:OLMITO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-0787
Mailing Address - Country:US
Mailing Address - Phone:956-443-0601
Mailing Address - Fax:
Practice Address - Street 1:800 W JEFFERSON ST STE 150
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-6358
Practice Address - Country:US
Practice Address - Phone:956-443-0601
Practice Address - Fax:833-728-1265
Is Sole Proprietor?:No
Enumeration Date:2020-10-22
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF06200069363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner