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General NPI Number Information
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NPI Number | 1033524517
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Entity Type | Organization
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Legal Business Name | PALM VALLEY EMERGENCY PHYSICIAN, SPECIALIST PLLC
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Dates
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Enumeration Date | 06/24/2014
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 1040 W JEFFERSON ST
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City | BROWNSVILLE
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State | TX
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Zip | 78520-6338
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Country | US
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Telephone | 956-698-5595
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Fax |
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Provider Business Mailing Address
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Address Line | 11125 ARKANSAS AVE
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City | BROWNSVILLE
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State | TX
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Zip | 78521-9389
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Country | US
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Telephone | 956-554-7417
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Fax |
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | MR. DAVID HERNANDEZ
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Credential | FNP-C
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Telephone | 956-455-6378
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP125734
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License Number State | TX
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