Provider Demographics
NPI:1326690025
Name:GRANADOS, VERONICA GOIRENA (FNP)
Entity Type:Individual
Prefix:
First Name:VERONICA
Middle Name:GOIRENA
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:EDNA
Mailing Address - State:TX
Mailing Address - Zip Code:77957-3721
Mailing Address - Country:US
Mailing Address - Phone:361-235-2639
Mailing Address - Fax:
Practice Address - Street 1:104 WATERMARK
Practice Address - Street 2:
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77904-1168
Practice Address - Country:US
Practice Address - Phone:361-220-7175
Practice Address - Fax:361-572-9163
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142210363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily