Provider Demographics
NPI:1306843347
Name:LLANES, JUAN ROBERTO (MSN, APRN FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:JUAN
Middle Name:ROBERTO
Last Name:LLANES
Suffix:
Gender:M
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 1:801 I J ST
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78501-1892
Mailing Address - Country:US
Mailing Address - Phone:956-802-7540
Mailing Address - Fax:956-682-4412
Practice Address - Street 1:202 PALMVIEW DR STE 1
Practice Address - Street 2:
Practice Address - City:PALMVIEW
Practice Address - State:TX
Practice Address - Zip Code:78572-9394
Practice Address - Country:US
Practice Address - Phone:956-225-2625
Practice Address - Fax:956-598-6069
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-06
Last Update Date:2020-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX533924363LF0000X
TXAP112583363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXQ11826Medicare UPIN
TX8B5041Medicare ID - Type Unspecified