Provider Demographics
NPI:1225842230
Name:DE LA GARZA, MARISSA (MSN, APRN, FNP-BC)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:DE LA GARZA
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SW AUGUSTA SQ
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503-1269
Mailing Address - Country:US
Mailing Address - Phone:361-673-3234
Mailing Address - Fax:
Practice Address - Street 1:501 SAVANNAH AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503-2929
Practice Address - Country:US
Practice Address - Phone:956-630-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-03
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1183720363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily