Healthcare Provider Details

I. General information

NPI: 1992204580
Provider Name (Legal Business Name): GEMMA B. STO NINO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2018
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

388 YPAO RD
TAMUNING GU
96913-3701
US

IV. Provider business mailing address

710 PACIFIC AVE
EDINBURG TX
78539-7356
US

V. Phone/Fax

Practice location:
  • Phone: 671-646-8881
  • Fax: 671-648-2548
Mailing address:
  • Phone: 956-624-7591
  • Fax: 888-924-0697

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number20NP02
License Number StateGU
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP135674
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP135674
License Number StateTX
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number20R64
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: