Provider Demographics
NPI:1053907451
Name:PANGAN, MARISSA (FNP-C)
Entity type:Individual
Prefix:
First Name:MARISSA
Middle Name:
Last Name:PANGAN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3466 DISCOVERY CREEK BLVD STE 600
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77386-7129
Mailing Address - Country:US
Mailing Address - Phone:281-440-5300
Mailing Address - Fax:
Practice Address - Street 1:3466 DISCOVERY CREEK BLVD
Practice Address - Street 2:
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77386-7125
Practice Address - Country:US
Practice Address - Phone:281-440-5300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1022819363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty