=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649871476
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARISSA FELICITAS CABRERA NP -C, BSN, RN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2020
-----------------------------------------------------
Last Update Date | 11/06/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 613 VICTORIA LN
-----------------------------------------------------
City | HARLINGEN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78550-0235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-421-1026
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 126 N CUATES DR
-----------------------------------------------------
City | LOS FRESNOS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78566-4314
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-404-3169
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | AP145422
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------