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General NPI Number Information
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NPI Number | 1285133512
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Entity Type | Organization
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Legal Business Name | EL PASO ADVANCE PRACTICE PROVIDER, PLLC
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Dates
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Enumeration Date | 02/01/2018
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 5080 POWDER RIVER LN
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City | EL PASO
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State | TX
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Zip | 79938-8286
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Country | US
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Telephone | 915-328-2311
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Fax |
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Provider Business Mailing Address
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Address Line | 1605 GEORGE DIETER DR STE 636
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City | EL PASO
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State | TX
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Zip | 79936-5600
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Country | US
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Telephone | 915-671-1371
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Fax | 915-219-9022
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Authorized Official
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Title or Position | CEO
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Name | TARON TARAY PEEBLES
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Credential | ANP
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Telephone | 915-532-2477
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343800000X
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Taxonomy Name | Secured Medical Transport (VAN)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 121725
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License Number State | TX
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