MEDICARE: MR. MICHAEL ANTHONY TIJERINA NP-C

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	363LF0000X	Family Nurse Practitioner	F0814683	TX

General Provider Information

NPI Number	:	1881095453
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MICHAEL ANTHONY TIJERINA NP-C

Provider Business Mailing Address
First Line	:	1704 MARCELLA AVE
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78040-7923
Country	:	US
Telephone Number	:	956-645-0709
Fax Number	:

Provider Business Practice Location Address
First Line	:	6999 MCPHERSON RD STE 220
Second Line	:
City	:	LAREDO
State	:	TX
Zip	:	78041-6451
Country	:	US
Telephone Number	:	956-795-4776
Fax Number	:	956-795-4779

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

Provider Enumeration Date	:	09/15/2014
Last Update Date	:	05/30/2025

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