Provider Demographics
NPI:1134539588
Name:GARZA, NANCY (PA)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:GARZA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 E FERN AVE
Mailing Address - Street 2:STE B-3
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-1466
Mailing Address - Country:US
Mailing Address - Phone:956-971-9548
Mailing Address - Fax:956-686-0928
Practice Address - Street 1:1301 E FERN AVE
Practice Address - Street 2:STE B-3
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78501-1466
Practice Address - Country:US
Practice Address - Phone:956-971-9548
Practice Address - Fax:956-686-0928
Is Sole Proprietor?:No
Enumeration Date:2014-05-06
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA08943363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX388052YLPSOtherWELLMED PTAN
TX348828001Medicaid