=====================================================
General NPI Number Information
=====================================================
NPI Number | 1346600426
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SANDRA E. FLORES, FNP-BC, STAFFING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/02/2016
-----------------------------------------------------
Last Update Date | 04/21/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1218 W MONTE CRISTO RD
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78541-3873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-287-4925
-----------------------------------------------------
Fax | 956-287-4815
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1218 W MONTE CRISTO RD
-----------------------------------------------------
City | EDINBURG
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78541-3873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-287-4925
-----------------------------------------------------
Fax | 956-287-4815
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MS. SANDRA ELIZABETH FLORES
-----------------------------------------------------
Credential | FNP-BC
-----------------------------------------------------
Telephone | 956-207-0608
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 703650
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------