Healthcare Provider Details

I. General information

NPI: 1053023168
Provider Name (Legal Business Name): ALEXANDRIA TIJERINA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2022
Last Update Date: 12/20/2022
Certification Date: 12/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2345 REAGAN ST
DALLAS TX
75219-3225
US

IV. Provider business mailing address

2345 REAGAN ST
DALLAS TX
75219-3225
US

V. Phone/Fax

Practice location:
  • Phone: 214-999-1044
  • Fax: 469-293-4663
Mailing address:
  • Phone: 214-766-0642
  • Fax: 512-371-6034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1036900
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: