Provider Demographics
NPI:1043093917
Name:SUAREZ PORTO, MIGUEL (FNP-C)
Entity Type:Individual
Prefix:
First Name:MIGUEL
Middle Name:
Last Name:SUAREZ PORTO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11819 PINEY BEND DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-7501
Mailing Address - Country:US
Mailing Address - Phone:281-662-3197
Mailing Address - Fax:
Practice Address - Street 1:7095A HIGHWAY 6 N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77095-2505
Practice Address - Country:US
Practice Address - Phone:831-793-7158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1016184363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner