Provider Demographics
NPI:1033510888
Name:DEANDRES, CAROLINA (NP)
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:DEANDRES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 MEDICAL CENTER BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-2928
Mailing Address - Country:US
Mailing Address - Phone:936-788-1030
Mailing Address - Fax:936-788-2844
Practice Address - Street 1:503 MEDICAL CENTER BLVD STE 100
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-2928
Practice Address - Country:US
Practice Address - Phone:936-788-1030
Practice Address - Fax:936-788-2844
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2016-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126029363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily