Provider Demographics
NPI:1609619923
Name:PHARIS, MARISSA RENE (MSN,APRN,FNP-C)
Entity type:Individual
Prefix:MRS
First Name:MARISSA
Middle Name:RENE
Last Name:PHARIS
Suffix:
Gender:F
Credentials:MSN,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 1:4391 COUNTY ROAD 945
Mailing Address - Street 2:
Mailing Address - City:BRAZORIA
Mailing Address - State:TX
Mailing Address - Zip Code:77422-7065
Mailing Address - Country:US
Mailing Address - Phone:979-417-1285
Mailing Address - Fax:
Practice Address - Street 1:400 HARBORSIDE DRIVE SUITE 110 ENTRANCE A
Practice Address - Street 2:
Practice Address - City:GALVESTON
Practice Address - State:TX
Practice Address - Zip Code:77555-0001
Practice Address - Country:US
Practice Address - Phone:832-632-7999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-14
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1001407363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily