Provider Demographics
NPI:1740767177
Name:NINO, ISAACC GUILLERMO (APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:ISAACC
Middle Name:GUILLERMO
Last Name:NINO
Suffix:
Gender:M
Credentials:APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 COFFEE MILL DR
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-1310
Mailing Address - Country:US
Mailing Address - Phone:956-878-2160
Mailing Address - Fax:
Practice Address - Street 1:3804 S. JACKSON RD., STE. #1
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-6101
Practice Address - Country:US
Practice Address - Phone:956-296-3001
Practice Address - Fax:956-396-3000
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-27
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX736520163W00000X
TXAP138261363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX403739202Medicaid
TXH08LW21601OtherBCBS