Provider Demographics
NPI:1518018886
Name:FITZGERALD, THELMA CAVAZOS (APRN FNP-BC PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:THELMA
Middle Name:CAVAZOS
Last Name:FITZGERALD
Suffix:
Gender:F
Credentials:APRN FNP-BC PMHNP-BC
Other - Prefix:
Other - First Name:THELMA
Other - Middle Name:
Other - Last Name:CAVAZOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, FNP , PMHNP
Mailing Address - Street 1:908 PAREDES LINE RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-2660
Mailing Address - Country:US
Mailing Address - Phone:956-682-4401
Mailing Address - Fax:956-664-9081
Practice Address - Street 1:3115 CENTER POINT DR
Practice Address - Street 2:
Practice Address - City:EDINBURG
Practice Address - State:TX
Practice Address - Zip Code:78539-8433
Practice Address - Country:US
Practice Address - Phone:956-296-1987
Practice Address - Fax:956-296-1538
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP111641363LP0808X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3674020-05Medicaid