Provider Demographics
NPI:1396212908
Name:JUAREZ, KRISTAL (FNP)
Entity Type:Individual
Prefix:
First Name:KRISTAL
Middle Name:
Last Name:JUAREZ
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KRISTAL
Other - Middle Name:J
Other - Last Name:GALLARDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:11925 PASEO DEL RIO CT
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3703
Mailing Address - Country:US
Mailing Address - Phone:915-246-0744
Mailing Address - Fax:
Practice Address - Street 1:1485 GEORGE DIETER DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79936-7650
Practice Address - Country:US
Practice Address - Phone:915-790-5700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-01
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139439363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty