Provider Demographics
NPI:1861945339
Name:BRISENO-LUCIO, MARTINA (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:BRISENO-LUCIO
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 S EXPRESSWAY 77
Mailing Address - Street 2:
Mailing Address - City:HARLINGEN
Mailing Address - State:TX
Mailing Address - Zip Code:78550-3213
Mailing Address - Country:US
Mailing Address - Phone:956-428-7710
Mailing Address - Fax:
Practice Address - Street 1:2310 N ED CAREY DR
Practice Address - Street 2:
Practice Address - City:HARLINGEN
Practice Address - State:TX
Practice Address - Zip Code:78550-8200
Practice Address - Country:US
Practice Address - Phone:956-428-5522
Practice Address - Fax:956-421-2759
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131560363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care