Provider Demographics
NPI:1467852855
Name:SYLVIA, VANESSA (NP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:SYLVIA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3817 POST OAK BLVD
Mailing Address - Street 2:
Mailing Address - City:CADDO MILLS
Mailing Address - State:TX
Mailing Address - Zip Code:75135-7439
Mailing Address - Country:US
Mailing Address - Phone:972-400-1668
Mailing Address - Fax:972-421-1799
Practice Address - Street 1:1400 PRESTON RD STE 400
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5189
Practice Address - Country:US
Practice Address - Phone:469-371-0289
Practice Address - Fax:877-884-3992
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX705214363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX340526803Medicaid
TX374070YKQLMedicare PIN
TX374070YKP5Medicare PIN
TX340526803Medicaid