Healthcare Provider Details

I. General information

NPI: 1285133512
Provider Name (Legal Business Name): EL PASO ADVANCE PRACTICE PROVIDER, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2018
Last Update Date: 06/06/2024
Certification Date: 06/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5080 POWDER RIVER LN
EL PASO TX
79938-8286
US

IV. Provider business mailing address

1605 GEORGE DIETER DR STE 636
EL PASO TX
79936-5600
US

V. Phone/Fax

Practice location:
  • Phone: 915-328-2311
  • Fax:
Mailing address:
  • Phone: 915-671-1371
  • Fax: 915-219-9022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number121725
License Number StateTX

VIII. Authorized Official

Name: TARON TARAY PEEBLES
Title or Position: CEO
Credential: ANP
Phone: 915-532-2477