Healthcare Provider Details

I. General information

NPI: 1902723828
Provider Name (Legal Business Name): DEANDRA MONIQUE APODACA AGACNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E AMADOR AVE
LAS CRUCES NM
88001-3660
US

IV. Provider business mailing address

451 HELENS PLACE
LAS CRUCES NM
88007
US

V. Phone/Fax

Practice location:
  • Phone: 575-288-2141
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number89959
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: