Healthcare Provider Details

I. General information

NPI: 1578108775
Provider Name (Legal Business Name): GABRIELLE OLIVAS APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2019
Last Update Date: 11/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E CLIFF DR STE 4D
EL PASO TX
79902-4846
US

IV. Provider business mailing address

1250 E CLIFF DR STE 4D
EL PASO TX
79902-4846
US

V. Phone/Fax

Practice location:
  • Phone: 915-577-9339
  • Fax:
Mailing address:
  • Phone: 915-577-9339
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License NumberAP143815
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: