Provider Demographics
NPI:1669523619
Name:TIJERINA, ANGELIQUE A (PA)
Entity type:Individual
Prefix:
First Name:ANGELIQUE
Middle Name:A
Last Name:TIJERINA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:ANGELIQUE
Other - Middle Name:
Other - Last Name:MURILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:135 VISION PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:TX
Mailing Address - Zip Code:77384-3001
Mailing Address - Country:US
Mailing Address - Phone:281-404-3000
Mailing Address - Fax:936-273-6911
Practice Address - Street 1:135 VISION PARK BLVD
Practice Address - Street 2:
Practice Address - City:SHENANDOAH
Practice Address - State:TX
Practice Address - Zip Code:77384-3001
Practice Address - Country:US
Practice Address - Phone:281-404-3000
Practice Address - Fax:936-273-6911
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2023-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA04249363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant