Provider Demographics
NPI:1124980024
Name:BRISENO, BIANCA JADE (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:JADE
Last Name:BRISENO
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 WINSLOW RUN
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-4567
Mailing Address - Country:US
Mailing Address - Phone:432-559-5412
Mailing Address - Fax:
Practice Address - Street 1:204 WINSLOW RUN
Practice Address - Street 2:
Practice Address - City:CIBOLO
Practice Address - State:TX
Practice Address - Zip Code:78108-4567
Practice Address - Country:US
Practice Address - Phone:432-559-5412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-29
Last Update Date:2025-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1212739363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care