Provider Demographics
NPI:1265071260
Name:LEAL, MARISSA SANCHEZ (APRN FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:SANCHEZ
Last Name:LEAL
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-3209
Mailing Address - Country:US
Mailing Address - Phone:361-643-4546
Mailing Address - Fax:361-758-2137
Practice Address - Street 1:2413 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-3209
Practice Address - Country:US
Practice Address - Phone:361-643-4546
Practice Address - Fax:361-758-2137
Is Sole Proprietor?:No
Enumeration Date:2019-12-23
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX694380207RE0101X
TXAP144411363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism