Provider Demographics
NPI:1316406549
Name:SEGURA, MARIO ELI (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MARIO
Middle Name:ELI
Last Name:SEGURA
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4631 S JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:EDINBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78539-7794
Mailing Address - Country:US
Mailing Address - Phone:956-271-0660
Mailing Address - Fax:956-525-4211
Practice Address - Street 1:4631 S JACKSON RD
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-7794
Practice Address - Country:US
Practice Address - Phone:956-271-0660
Practice Address - Fax:956-525-4211
Is Sole Proprietor?:No
Enumeration Date:2019-03-18
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP140992363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily