Provider Demographics
NPI:1407865017
Name:GAUTREAU, ROXANE K (FNP)
Entity Type:Individual
Prefix:
First Name:ROXANE
Middle Name:K
Last Name:GAUTREAU
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:PO BOX 259
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77377-0259
Mailing Address - Country:US
Mailing Address - Phone:281-357-0111
Mailing Address - Fax:281-255-9639
Practice Address - Street 1:27933 TOMBALL PKWY
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6415
Practice Address - Country:US
Practice Address - Phone:281-357-0111
Practice Address - Fax:281-255-9639
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX660525363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP32318Medicare UPIN
TX8K4242Medicare PIN