Healthcare Provider Details

I. General information

NPI: 1689419541
Provider Name (Legal Business Name): ANTHONY CARUSO FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2024
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4521 S STAPLES ST STE 100
CORPUS CHRISTI TX
78411-2603
US

IV. Provider business mailing address

4521 S STAPLES ST STE 100
CORPUS CHRISTI TX
78411-2603
US

V. Phone/Fax

Practice location:
  • Phone: 361-724-3892
  • Fax: 361-730-1052
Mailing address:
  • Phone: 361-724-3892
  • Fax: 361-730-1052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1167881
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: