MEDICARE: EISTLE MARIE REGUYAL UY 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
1	363LF0000X	Family Nurse Practitioner	AP141589	TX

General Provider Information

NPI Number	:	1962068346
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EISTLE MARIE REGUYAL UY FNP-C

Provider Business Mailing Address
First Line	:	1908 N LAURENT ST STE 250
Second Line	:
City	:	VICTORIA
State	:	TX
Zip	:	77901-5417
Country	:	US
Telephone Number	:	361-576-0694
Fax Number	:

Provider Business Practice Location Address
First Line	:	5215 S SUGAR RD
Second Line	:
City	:	EDINBURG
State	:	TX
Zip	:	78539-0080
Country	:	US
Telephone Number	:	956-782-9666
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2019
Last Update Date	:	02/04/2026

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