Provider Demographics
NPI:1275279556
Name:FONSECA, ERICA (DNP, BSN, RN)
Entity Type:Individual
Prefix:DR
First Name:ERICA
Middle Name:
Last Name:FONSECA
Suffix:
Gender:F
Credentials:DNP, BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21503 RIVERTON RISE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78261-2562
Mailing Address - Country:US
Mailing Address - Phone:956-357-0298
Mailing Address - Fax:
Practice Address - Street 1:12141 RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77082-2408
Practice Address - Country:US
Practice Address - Phone:281-558-3444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-09
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1091402363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal