Provider Demographics
NPI:1710301445
Name:CARDENAS, GERLIE ILAG
Entity Type:Individual
Prefix:
First Name:GERLIE
Middle Name:ILAG
Last Name:CARDENAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 ARDMORE WAY
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-8615
Mailing Address - Country:US
Mailing Address - Phone:347-557-3981
Mailing Address - Fax:
Practice Address - Street 1:8224 PARK LN
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231-6011
Practice Address - Country:US
Practice Address - Phone:214-266-0266
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-17
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF338359363LF0000X
TXAP135978363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily