Provider Demographics
NPI:1497379598
Name:CAVAZOS, ELIANDRA (FNP-C)
Entity Type:Individual
Prefix:
First Name:ELIANDRA
Middle Name:
Last Name:CAVAZOS
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 1:1114 N CESAR CHAVEZ RD
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:TX
Mailing Address - Zip Code:78516-6897
Mailing Address - Country:US
Mailing Address - Phone:956-207-3124
Mailing Address - Fax:
Practice Address - Street 1:1700 W DOVE AVE
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78504-4463
Practice Address - Country:US
Practice Address - Phone:956-467-5920
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP114915363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP144915Medicaid