Basic Information
| Provider Information | |||||||||
| NPI: | 1609805753 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TIJERINA | ||||||||
| FirstName: | PATRICIA | ||||||||
| MiddleName: | M. | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | WHNP, LPA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1515 PAPPAS ST. | ||||||||
| Address2: | |||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780411705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9565233642 | ||||||||
| FaxNumber: | 9567958135 | ||||||||
| Practice Location | |||||||||
| Address1: | 1515 PAPPAS ST. | ||||||||
| Address2: | |||||||||
| City: | LAREDO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 780401705 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9565233642 | ||||||||
| FaxNumber: | 9567186294 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2006 | ||||||||
| LastUpdateDate: | 12/06/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LW0102X | 517474 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Women's Health |
ID Information
| ID | Type | State | Issuer | Description | 102265903 | 05 | TX | MEDICAID |