Healthcare Provider Details

I. General information

NPI: 1063377653
Provider Name (Legal Business Name): TONY HERRERA APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23900 KATY FWY
KATY TX
77494-1323
US

IV. Provider business mailing address

18403 S RAVEN SHORE DR
CYPRESS TX
77433-2422
US

V. Phone/Fax

Practice location:
  • Phone: 713-500-7207
  • Fax:
Mailing address:
  • Phone: 713-500-7207
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1174121
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: