Healthcare Provider Details

I. General information

NPI: 1962035337
Provider Name (Legal Business Name): BOBBI EUGENIA DERAS NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/13/2020
Last Update Date: 08/01/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CORPORATE BLVD
LAFAYETTE LA
70508-3870
US

IV. Provider business mailing address

4305 N MESA ST STE B
EL PASO TX
79902-1124
US

V. Phone/Fax

Practice location:
  • Phone: 915-222-2668
  • Fax:
Mailing address:
  • Phone: 915-779-7378
  • Fax: 915-779-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number788601
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberAP145764
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: