Provider Demographics
NPI:1679263834
Name:GALLARDO, AMADA ROXANA (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:AMADA
Middle Name:ROXANA
Last Name:GALLARDO
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:AMADA
Other - Middle Name:ROXANA
Other - Last Name:QUINTERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:429 BRYAN CT
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2563
Mailing Address - Country:US
Mailing Address - Phone:956-949-6524
Mailing Address - Fax:
Practice Address - Street 1:4151 JAIME ZAPATA MEMORIAL HWY STE 101B
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78043-4741
Practice Address - Country:US
Practice Address - Phone:956-729-9738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-11
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily