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General NPI Number Information
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NPI Number | 1194531343
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Entity Type | Individual
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Provider Name | EMILY PORTILLO
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Gender | Female
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Dates
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Enumeration Date | 12/03/2024
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 1310 PALUXY RD
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City | GRANBURY
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State | TX
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Zip | 76048-5655
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Country | US
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Telephone | 817-573-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 351 MAIN ST
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City | ATLANTIC BEACH
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State | FL
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Zip | 32233-2529
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Country | US
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Telephone | 717-307-0813
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 1180061
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 1180061
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License Number State | TX
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