Provider Demographics
NPI:1710266705
Name:FREDERICK, ERIN ELIZABETH (AGNP)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:ELIZABETH
Last Name:FREDERICK
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:E
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3801 W 15TH ST STE 320
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-7767
Mailing Address - Country:US
Mailing Address - Phone:972-985-8838
Mailing Address - Fax:844-292-1457
Practice Address - Street 1:3801 W 15TH ST STE 320
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-7767
Practice Address - Country:US
Practice Address - Phone:972-985-8838
Practice Address - Fax:844-292-1457
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR147719-5163W00000X
TX1097940363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No163W00000XNursing Service ProvidersRegistered Nurse