Healthcare Provider Details

I. General information

NPI: 1073086229
Provider Name (Legal Business Name): ROBERT DA SILVA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2019
Last Update Date: 12/24/2019
Certification Date: 12/24/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 RIVER POINTE DR STE 120
CONROE TX
77304-2817
US

IV. Provider business mailing address

200 RIVER POINTE DR STE 120
CONROE TX
77304-2817
US

V. Phone/Fax

Practice location:
  • Phone: 936-756-2555
  • Fax: 936-756-2534
Mailing address:
  • Phone: 936-756-2555
  • Fax: 936-756-2534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP139362
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: