Healthcare Provider Details

I. General information

NPI: 1114436227
Provider Name (Legal Business Name): AMY C MURILLO FNP-C, ENP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2017
Last Update Date: 05/07/2021
Certification Date: 05/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2830 CALDER ST
BEAUMONT TX
77702-1809
US

IV. Provider business mailing address

2830 CALDER ST
BEAUMONT TX
77702-1809
US

V. Phone/Fax

Practice location:
  • Phone: 409-892-7171
  • Fax:
Mailing address:
  • Phone: 281-997-4400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP135142
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: