Provider Demographics
NPI:1669012357
Name:FRORENZA-HUBBARD, ERIC WAYNE (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:WAYNE
Last Name:FRORENZA-HUBBARD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 MORNING MIMOSA CT
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89012-4904
Mailing Address - Country:US
Mailing Address - Phone:702-285-9027
Mailing Address - Fax:
Practice Address - Street 1:2250 E FLAMINGO RD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89119-5170
Practice Address - Country:US
Practice Address - Phone:702-784-4300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-09
Last Update Date:2022-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2220363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant