Provider Demographics
NPI:1730760463
Name:NIETO, TANA MARIE (MD)
Entity type:Individual
Prefix:
First Name:TANA
Middle Name:MARIE
Last Name:NIETO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:11511 SHADOW CREEK PKWY
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-7298
Mailing Address - Country:US
Mailing Address - Phone:713-442-0000
Mailing Address - Fax:
Practice Address - Street 1:605 S CONROE MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4722
Practice Address - Country:US
Practice Address - Phone:936-539-4004
Practice Address - Fax:936-521-3964
Is Sole Proprietor?:No
Enumeration Date:2021-04-15
Last Update Date:2024-07-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TXV0078207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine