Provider Demographics
NPI:1679789291
Name:ERVIN, DENIM RENEE (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:DENIM
Middle Name:RENEE
Last Name:ERVIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:DENIM
Other - Middle Name:RENEE
Other - Last Name:HOLLAND, SEALS, BOLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, BC, FNP
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-0813
Practice Address - Street 1:3550 NE LOOP 286
Practice Address - Street 2:
Practice Address - City:PARIS
Practice Address - State:TX
Practice Address - Zip Code:75460-5004
Practice Address - Country:US
Practice Address - Phone:903-785-0031
Practice Address - Fax:903-784-6755
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03157363LF0000X
TXR26629363LF0000X
OK95843363LF0000X
TXAP115721208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily