Provider Demographics
NPI:1013686542
Name:BURCIAGA, MARTIN (FNP)
Entity Type:Individual
Prefix:
First Name:MARTIN
Middle Name:
Last Name:BURCIAGA
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6000 NORTHERN PASS DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79911-7206
Mailing Address - Country:US
Mailing Address - Phone:915-264-1830
Mailing Address - Fax:915-264-1840
Practice Address - Street 1:6000 NORTHERN PASS DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79911-7206
Practice Address - Country:US
Practice Address - Phone:915-264-1830
Practice Address - Fax:915-264-1840
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2022-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1047241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily