Healthcare Provider Details

I. General information

NPI: 1720828627
Provider Name (Legal Business Name): CLARISSA TIJERINA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/29/2024
Last Update Date: 05/29/2024
Certification Date: 05/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 E 3RD ST
ALICE TX
78332-4705
US

IV. Provider business mailing address

305 E 3RD ST
ALICE TX
78332-4705
US

V. Phone/Fax

Practice location:
  • Phone: 361-664-9353
  • Fax: 361-668-1630
Mailing address:
  • Phone: 361-664-9353
  • Fax: 361-668-1630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1001671
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: