Healthcare Provider Details

I. General information

NPI: 1033510888
Provider Name (Legal Business Name): CAROLINA DEANDRES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2014
Last Update Date: 05/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

503 MEDICAL CENTER BLVD STE 100
CONROE TX
77304-2928
US

IV. Provider business mailing address

503 MEDICAL CENTER BLVD STE 100
CONROE TX
77304-2928
US

V. Phone/Fax

Practice location:
  • Phone: 936-788-1030
  • Fax: 936-788-2844
Mailing address:
  • Phone: 936-788-1030
  • Fax: 936-788-2844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP126029
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: