Healthcare Provider Details

I. General information

NPI: 1356902837
Provider Name (Legal Business Name): MONICA MONAE DEITZ FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/25/2019
Last Update Date: 05/30/2025
Certification Date: 05/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5022 HOLLY RD STE 1065022
CORPUS CHRISTI TX
78411-4761
US

IV. Provider business mailing address

5022 HOLLY RD STE 106
CORPUS CHRISTI TX
78411-4760
US

V. Phone/Fax

Practice location:
  • Phone: 210-253-3426
  • Fax:
Mailing address:
  • Phone: 210-253-3426
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP141973
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: