Provider Demographics
NPI:1992409007
Name:GARZA, IDA MARIE (NP)
Entity type:Individual
Prefix:MRS
First Name:IDA
Middle Name:MARIE
Last Name:GARZA
Suffix:
Gender:
Credentials:NP
Other - Prefix:MS
Other - First Name:IDA
Other - Middle Name:MARIE
Other - Last Name:LEITHEAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:7909 FREDERICKSBURG RD STE 110
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3400
Mailing Address - Country:US
Mailing Address - Phone:210-286-3048
Mailing Address - Fax:
Practice Address - Street 1:2020 SUNDANCE PKWY STE A1
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-2771
Practice Address - Country:US
Practice Address - Phone:830-246-2115
Practice Address - Fax:830-730-4127
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1114123363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner