Healthcare Provider Details

I. General information

NPI: 1881095453
Provider Name (Legal Business Name): MICHAEL ANTHONY TIJERINA NP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6999 MCPHERSON RD STE 220
LAREDO TX
78041-6451
US

IV. Provider business mailing address

1704 MARCELLA AVE
LAREDO TX
78040-7923
US

V. Phone/Fax

Practice location:
  • Phone: 956-795-4776
  • Fax: 956-795-4779
Mailing address:
  • Phone: 956-645-0709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF0814683
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: