Healthcare Provider Details

I. General information

NPI: 1750207395
Provider Name (Legal Business Name): BRUSLY ELIO HERNANDEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2026
Last Update Date: 06/27/2026
Certification Date: 06/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4914 CREEKSIDE HAVEN TRL
SPRING TX
77389-1849
US

IV. Provider business mailing address

4914 CREEKSIDE HAVEN TRL
SPRING TX
77389-1849
US

V. Phone/Fax

Practice location:
  • Phone: 281-866-1607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number12401202
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: