Provider Demographics
NPI:1518729045
Name:COLLASO, DANIELLA JUSTINE (FNP-BC)
Entity Type:Individual
Prefix:MS
First Name:DANIELLA
Middle Name:JUSTINE
Last Name:COLLASO
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 RANCHO VIEJO BLVD
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-9427
Mailing Address - Country:US
Mailing Address - Phone:956-455-7066
Mailing Address - Fax:
Practice Address - Street 1:7500 RIALTO BLVD STE 140
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78735-8531
Practice Address - Country:US
Practice Address - Phone:512-730-3060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-30
Last Update Date:2024-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1012079363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily