Healthcare Provider Details

I. General information

NPI: 1467852855
Provider Name (Legal Business Name): VANESSA SYLVIA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 06/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PRESTON RD STE 400
PLANO TX
75093-5189
US

IV. Provider business mailing address

3817 POST OAK BLVD
CADDO MILLS TX
75135-7439
US

V. Phone/Fax

Practice location:
  • Phone: 469-371-0289
  • Fax: 877-884-3992
Mailing address:
  • Phone: 972-400-1668
  • Fax: 972-421-1799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number705214
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: