Provider Demographics
NPI:1558762328
Name:CANALES, ELVA AZENETH (FNP-BC)
Entity Type:Individual
Prefix:
First Name:ELVA
Middle Name:AZENETH
Last Name:CANALES
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 1:2706 OKANE ST
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78043-2409
Mailing Address - Country:US
Mailing Address - Phone:956-324-3762
Mailing Address - Fax:
Practice Address - Street 1:3527 JAIME ZAPATA MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4788
Practice Address - Country:US
Practice Address - Phone:956-722-5007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily