Healthcare Provider Details

I. General information

NPI: 1053501379
Provider Name (Legal Business Name): DEBORAH SUSAN SKORUPPA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2007
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5348 PRAIRIE RIDGE DR
ROBSTOWN TX
78380
US

IV. Provider business mailing address

5348 PRAIRIE RIDGE DR
ROBSTOWN TX
78380-5898
US

V. Phone/Fax

Practice location:
  • Phone: 361-387-3779
  • Fax:
Mailing address:
  • Phone: 361-387-3779
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number251321
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: