Provider Demographics
NPI:1114281243
Name:VELAZQUEZ DONG, DEENA DENISE (FNP-C, PMHNP-C)
Entity Type:Individual
Prefix:
First Name:DEENA
Middle Name:DENISE
Last Name:VELAZQUEZ DONG
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 N GEORGETOWN ST
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3289
Mailing Address - Country:US
Mailing Address - Phone:512-244-8200
Mailing Address - Fax:512-244-8403
Practice Address - Street 1:1009 N GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-3289
Practice Address - Country:US
Practice Address - Phone:512-244-8200
Practice Address - Fax:512-244-8403
Is Sole Proprietor?:No
Enumeration Date:2012-07-04
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX787540363LF0000X
TX122027363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080462703Medicaid
TX080462703Medicaid