Healthcare Provider Details

I. General information

NPI: 1235720293
Provider Name (Legal Business Name): STEPHANIE TIJERINA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2021
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3327 RESEARCH PLZ STE 403
SAN ANTONIO TX
78235-5159
US

IV. Provider business mailing address

7909 FREDERICKSBURG RD STE 110
SAN ANTONIO TX
78229-3400
US

V. Phone/Fax

Practice location:
  • Phone: 210-337-6228
  • Fax:
Mailing address:
  • Phone: 210-614-4544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1028942
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: