Healthcare Provider Details

I. General information

NPI: 1972104347
Provider Name (Legal Business Name): JUANITA PARRA FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2020
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3017 TRAWOOD DR
EL PASO TX
79936-4330
US

IV. Provider business mailing address

3017 TRAWOOD DR
EL PASO TX
79936-4330
US

V. Phone/Fax

Practice location:
  • Phone: 915-855-2005
  • Fax: 915-855-8400
Mailing address:
  • Phone: 915-855-2005
  • Fax: 915-855-8400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1017500
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: