Provider Demographics
NPI:1588972046
Name:DUNCAN, MARITZA TIJERINA (ACNP-BC)
Entity type:Individual
Prefix:
First Name:MARITZA
Middle Name:TIJERINA
Last Name:DUNCAN
Suffix:
Gender:F
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:MARITZA
Other - Middle Name:
Other - Last Name:CANTU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10007 HUEBNER RD STE 402
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78240-1640
Mailing Address - Country:US
Mailing Address - Phone:210-692-0361
Mailing Address - Fax:210-692-0151
Practice Address - Street 1:10007 HUEBNER RD BLDG 4
Practice Address - Street 2:STE 402
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240-7824
Practice Address - Country:US
Practice Address - Phone:210-692-0361
Practice Address - Fax:210-593-4066
Is Sole Proprietor?:No
Enumeration Date:2010-09-18
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX698646363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1O7633OtherMEDICARE