Healthcare Provider Details

I. General information

NPI: 1417372418
Provider Name (Legal Business Name): CHERYL BREAUX APRN-FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 06/25/2024
Certification Date: 06/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 HARBORSIDE DR FL 5
GALVESTON TX
77555-0001
US

IV. Provider business mailing address

350 N TEXAS AVE SUITE A-2
WEBSTER TX
77598-4959
US

V. Phone/Fax

Practice location:
  • Phone: 409-772-6781
  • Fax: 409-772-4456
Mailing address:
  • Phone: 281-616-6017
  • Fax: 281-947-3037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number617300
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberAP125135
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: