Healthcare Provider Details

I. General information

NPI: 1063210573
Provider Name (Legal Business Name): BRIANNA NICOLE TIJERINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2009 N TEXAS AVE
LAREDO TX
78043-2749
US

IV. Provider business mailing address

2009 N TEXAS AVE
LAREDO TX
78043-2749
US

V. Phone/Fax

Practice location:
  • Phone: 956-489-6657
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: