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NPI Code Detail

MEDICARE: MRS. IAN MARIE DE PERALTA CARINO APRN, FNP-C

MEDICARE: MRS. IAN MARIE DE PERALTA CARINO APRN, FNP-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363LF0000XFamily Nurse Practitioner1203517TX

General Provider Information

NPI Number : 1679460190
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. IAN MARIE DE PERALTA CARINO APRN, FNP-C
Provider Business Mailing Address
First Line : PO BOX 270432
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78427-0432
Country : US
Telephone Number : 361-765-4713
Fax Number :
Provider Business Practice Location Address
First Line : 6330 SARATOGA BLVD
Second Line :
City : CORPUS CHRISTI
State : TX
Zip : 78414-3481
Country : US
Telephone Number : 361-415-2414
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2025
Last Update Date : 06/18/2025

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