Provider Demographics
NPI:1396186185
Name:BAQUIRIN, NANCY C (FNP-C)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:C
Last Name:BAQUIRIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2129
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79760-2129
Mailing Address - Country:US
Mailing Address - Phone:432-640-2749
Mailing Address - Fax:432-640-2746
Practice Address - Street 1:1940 E 42ND ST
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79762-5803
Practice Address - Country:US
Practice Address - Phone:432-640-2749
Practice Address - Fax:432-640-2746
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP123900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM61103551Medicaid
TX357257003Medicaid
NM61103551Medicaid
TX1D1797OtherMEDICARE