Provider Demographics
NPI:1619386190
Name:CANTAZARO, MAYRA JUDITH (FNP)
Entity type:Individual
Prefix:MRS
First Name:MAYRA
Middle Name:JUDITH
Last Name:CANTAZARO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7017 N. 10TH ST
Mailing Address - Street 2:STE N2 #218
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78504-0809
Mailing Address - Country:US
Mailing Address - Phone:956-603-1555
Mailing Address - Fax:956-800-6369
Practice Address - Street 1:4113 CROSSPOINT BLVD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-1803
Practice Address - Country:US
Practice Address - Phone:956-603-1555
Practice Address - Fax:956-800-6369
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2021-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126113363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX342495401Medicaid
TX376247YY3FMedicare PIN