Provider Demographics
NPI:1578010500
Name:UT HEALTH SCIENCE CENTER - PEDIATRIC PULMONARY
Entity Type:Organization
Organization Name:UT HEALTH SCIENCE CENTER - PEDIATRIC PULMONARY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:CANDICE
Authorized Official - Middle Name:
Authorized Official - Last Name:DA COSTA - PANY
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:832-533-5988
Mailing Address - Street 1:6410 FANNIN ST STE 500
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-3005
Mailing Address - Country:US
Mailing Address - Phone:832-325-6516
Mailing Address - Fax:
Practice Address - Street 1:6410 FANNIN ST STE 500
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-3005
Practice Address - Country:US
Practice Address - Phone:832-325-6516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131407363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty