Provider Demographics
NPI:1114403714
Name:VARGAS, ERICK (RN)
Entity Type:Individual
Prefix:
First Name:ERICK
Middle Name:
Last Name:VARGAS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1138 HOLLAND DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75040-9014
Mailing Address - Country:US
Mailing Address - Phone:469-610-1250
Mailing Address - Fax:
Practice Address - Street 1:1138 HOLLAND DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75040-9014
Practice Address - Country:US
Practice Address - Phone:469-610-1250
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-17
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX947668163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse