Provider Demographics
NPI:1639673494
Name:BRAVO, MONICA RENEE (NP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:RENEE
Last Name:BRAVO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 DIAMOND ROSE DR
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-0817
Mailing Address - Country:US
Mailing Address - Phone:817-319-9877
Mailing Address - Fax:
Practice Address - Street 1:224 DIAMOND ROSE DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-0817
Practice Address - Country:US
Practice Address - Phone:817-319-9877
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-19
Last Update Date:2018-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP136635363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily