Provider Demographics
NPI:1235530288
Name:CARRILLO, NATIVIDAD (MSN, APRN, FNP-BC)
Entity Type:Individual
Prefix:
First Name:NATIVIDAD
Middle Name:
Last Name:CARRILLO
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2917 MIDWAY RD
Mailing Address - Street 2:
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-9406
Mailing Address - Country:US
Mailing Address - Phone:956-536-6966
Mailing Address - Fax:956-377-5250
Practice Address - Street 1:1315 E 6TH ST
Practice Address - Street 2:
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4200
Practice Address - Country:US
Practice Address - Phone:956-351-5949
Practice Address - Fax:956-351-5946
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-09
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125897363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily