Provider Demographics
NPI:1750750030
Name:MONTECILLO, JOSE TIRSO (FNP-C)
Entity type:Individual
Prefix:MR
First Name:JOSE
Middle Name:TIRSO
Last Name:MONTECILLO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2009 DARTMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-5767
Mailing Address - Country:US
Mailing Address - Phone:956-789-8833
Mailing Address - Fax:
Practice Address - Street 1:2009 DARTMOUTH AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-5767
Practice Address - Country:US
Practice Address - Phone:956-789-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-17
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP129346363LF0000X
TXF0915006363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily