Provider Demographics
NPI:1538703178
Name:SOBERANES, RICKIE JEAN (FNP-C)
Entity Type:Individual
Prefix:
First Name:RICKIE
Middle Name:JEAN
Last Name:SOBERANES
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 1:615 N ZARAGOZA RD STE 86
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79907-4772
Mailing Address - Country:US
Mailing Address - Phone:915-516-6868
Mailing Address - Fax:915-516-6869
Practice Address - Street 1:615 N ZARAGOZA RD STE 86
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-4772
Practice Address - Country:US
Practice Address - Phone:915-516-6868
Practice Address - Fax:915-516-6869
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-06
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP143372363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty