Provider Demographics
NPI:1881134708
Name:CONJE, TU RICCEL (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:TU RICCEL
Middle Name:
Last Name:CONJE
Suffix:
Gender:M
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 GLASSCOCK
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78541-8156
Mailing Address - Country:US
Mailing Address - Phone:956-330-3176
Mailing Address - Fax:
Practice Address - Street 1:1401 E 8TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-6640
Practice Address - Country:US
Practice Address - Phone:833-887-4863
Practice Address - Fax:956-296-6857
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-24
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133420363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX368964803Medicaid
TXH08LW85301OtherBCBS