Healthcare Provider Details

I. General information

NPI: 1306843347
Provider Name (Legal Business Name): JUAN ROBERTO LLANES MSN, APRN FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2005
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 PALMVIEW DR STE 1
PALMVIEW TX
78572-9394
US

IV. Provider business mailing address

801 I J ST
MCALLEN TX
78501-1892
US

V. Phone/Fax

Practice location:
  • Phone: 956-225-2625
  • Fax: 956-598-6069
Mailing address:
  • Phone: 956-802-7540
  • Fax: 956-682-4412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number533924
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP112583
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: