MEDICARE: MARITZA TIJERINA DUNCAN ACNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	698646	TX

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1O7633	OTHER	TX	MEDICARE

General Provider Information

NPI Number	:	1588972046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARITZA TIJERINA DUNCAN ACNP-BC

Provider Business Mailing Address
First Line	:	10007 HUEBNER RD STE 402
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-1640
Country	:	US
Telephone Number	:	210-692-0361
Fax Number	:	210-692-0151

Provider Business Practice Location Address
First Line	:	10007 HUEBNER RD BLDG 4
Second Line	:	STE 402
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-7824
Country	:	US
Telephone Number	:	210-692-0361
Fax Number	:	210-593-4066

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/18/2010
Last Update Date	:	05/17/2021

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