1013041110 NPI number — MRS. FERMINA AMARILIS ESPAILLAT CNS-WHNP

Table of content: MRS. FERMINA AMARILIS ESPAILLAT CNS-WHNP (NPI 1013041110)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013041110 NPI number — MRS. FERMINA AMARILIS ESPAILLAT CNS-WHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ESPAILLAT
Provider First Name:
FERMINA
Provider Middle Name:
AMARILIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
CNS-WHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ESPAILLAT
Provider Other First Name:
FERMINA
Provider Other Middle Name:
AMARILIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
CNS-WHNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1013041110
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3102 MINTHORN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KILLEEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76542-1932
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-554-3347
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
108 E HALSTEAD AVE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
COPPERAS COVE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76522-1825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-547-4673
Provider Business Practice Location Address Fax Number:
254-547-7653
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 364SW0102X , with the licence number:  628558 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WW0101X , with the licence number: 628558 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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