Provider Demographics
NPI:1902322258
Name:MORALES, TANIA (NP)
Entity type:Individual
Prefix:
First Name:TANIA
Middle Name:
Last Name:MORALES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 N BRYAN RD
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6285
Mailing Address - Country:US
Mailing Address - Phone:956-580-3303
Mailing Address - Fax:956-580-1505
Practice Address - Street 1:611 N BRYAN RD
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572
Practice Address - Country:US
Practice Address - Phone:956-580-3303
Practice Address - Fax:956-580-1505
Is Sole Proprietor?:No
Enumeration Date:2017-08-18
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134899363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX386140301Medicaid
TX680580OtherMEDICARE
TXAP134899OtherAP134899