Provider Demographics
NPI:1225830565
Name:SONGCUYA, MA LYNE MACARIO (AGACNP)
Entity type:Individual
Prefix:
First Name:MA LYNE
Middle Name:MACARIO
Last Name:SONGCUYA
Suffix:
Gender:
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7503 HARVEST BAY
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78253-6697
Mailing Address - Country:US
Mailing Address - Phone:210-307-7214
Mailing Address - Fax:
Practice Address - Street 1:7503 HARVEST BAY
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78253-6697
Practice Address - Country:US
Practice Address - Phone:210-307-7214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-03-26
Last Update Date:2025-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1193707363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care