Healthcare Provider Details

I. General information

NPI: 1720451461
Provider Name (Legal Business Name): MARIA CISNEROS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2015
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2606 HOSPITAL BLVD BLDG 4
CORPUS CHRISTI TX
78405-1804
US

IV. Provider business mailing address

919 HIDDEN RDG
IRVING TX
75038-3813
US

V. Phone/Fax

Practice location:
  • Phone: 361-902-6100
  • Fax: 361-902-6935
Mailing address:
  • Phone: 469-282-2711
  • Fax: 469-282-0996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP128918
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: