Provider Demographics
NPI:1558869487
Name:ESTRADA, MAXINE (FNP-C)
Entity Type:Individual
Prefix:
First Name:MAXINE
Middle Name:
Last Name:ESTRADA
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 1:8308 INSPIRATION LN
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-8599
Mailing Address - Country:US
Mailing Address - Phone:432-230-0110
Mailing Address - Fax:
Practice Address - Street 1:3425 GRANDE BULEVAR
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75062-5108
Practice Address - Country:US
Practice Address - Phone:972-639-5836
Practice Address - Fax:972-639-5836
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-25
Last Update Date:2018-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine