Healthcare Provider Details

I. General information

NPI: 1497002067
Provider Name (Legal Business Name): MARITA SILVIA THIES APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2012
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12952 BANDERA RD STE 105
HELOTES TX
78023-4690
US

IV. Provider business mailing address

12952 BANDERA RD STE 105
HELOTES TX
78023-4690
US

V. Phone/Fax

Practice location:
  • Phone: 210-695-1900
  • Fax: 833-464-5140
Mailing address:
  • Phone: 210-695-1900
  • Fax: 833-464-5140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number683951
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: