Provider Demographics
NPI:1720862816
Name:RICENBAW, BRIANNA DEONE (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:DEONE
Last Name:RICENBAW
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:DEONE
Other - Last Name:HAGEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3501 S SONCY RD STE 150
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79119-6426
Mailing Address - Country:US
Mailing Address - Phone:806-212-6353
Mailing Address - Fax:806-212-0558
Practice Address - Street 1:3501 S SONCY RD
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79119-6440
Practice Address - Country:US
Practice Address - Phone:806-212-6353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-21
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1132846363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily