Healthcare Provider Details

I. General information

NPI: 1558696278
Provider Name (Legal Business Name): ERIK TIJERINA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/14/2009
Last Update Date: 06/30/2020
Certification Date: 06/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 W MAIN ST STE C
GUN BARREL CITY TX
75156-5404
US

IV. Provider business mailing address

815 E ROYALL BLVD STE 3
MALAKOFF TX
75148-9255
US

V. Phone/Fax

Practice location:
  • Phone: 903-802-9062
  • Fax:
Mailing address:
  • Phone: 903-489-0101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number693274
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: