1518018886 NPI number — THELMA CAVAZOS FITZGERALD APRN FNP-BC PMHNP-BC

Table of content: THELMA CAVAZOS FITZGERALD APRN FNP-BC PMHNP-BC (NPI 1518018886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518018886 NPI number — THELMA CAVAZOS FITZGERALD APRN FNP-BC PMHNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FITZGERALD
Provider First Name:
THELMA
Provider Middle Name:
CAVAZOS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN FNP-BC PMHNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CAVAZOS
Provider Other First Name:
THELMA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN, FNP , PMHNP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518018886
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/24/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 PAREDES LINE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78521-2660
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-682-4401
Provider Business Mailing Address Fax Number:
956-664-9081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2902 HAINE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-8969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-296-4000
Provider Business Practice Location Address Fax Number:
956-296-2842
Provider Enumeration Date:
01/15/2007

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: 363LF0000X , with the licence number:  AP111641 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X , with the licence number: AP111641 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 3674020-05 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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