Provider Demographics
NPI:1437846177
Name:VARGAS, ERICA MARINA (PA)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:MARINA
Last Name:VARGAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:MARINA
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MLS
Mailing Address - Street 1:4805 CAUSEWAY CT
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76549-3772
Mailing Address - Country:US
Mailing Address - Phone:254-319-5809
Mailing Address - Fax:
Practice Address - Street 1:4805 CAUSEWAY CT
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76549-3772
Practice Address - Country:US
Practice Address - Phone:254-319-5809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-21
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant