Provider Demographics
NPI:1750043626
Name:LUPERCIO, CAROLINE TRIANA (FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:CAROLINE
Middle Name:TRIANA
Last Name:LUPERCIO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 ROSS ST STE 100
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79102-4411
Mailing Address - Country:US
Mailing Address - Phone:806-418-6966
Mailing Address - Fax:
Practice Address - Street 1:1200 ROSS ST STE 100
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-4411
Practice Address - Country:US
Practice Address - Phone:806-418-6966
Practice Address - Fax:806-418-6967
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1056569363L00000X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1056569OtherTEXAS BOARD OF NURSING
TX905585OtherTEXAS BOARD OF NURSING RN LICENSURE