Provider Demographics
NPI:1760050470
Name:AYALA, JOE JR (STUDENT FNP, BSN, RN)
Entity Type:Individual
Prefix:MR
First Name:JOE
Middle Name:
Last Name:AYALA
Suffix:JR
Gender:M
Credentials:STUDENT FNP, BSN, RN
Other - Prefix:MR
Other - First Name:JOSE
Other - Middle Name:
Other - Last Name:AYALA
Other - Suffix:JR
Other - Last Name Type:Other Name
Other - Credentials:STUDENT FNP, BSN, RN
Mailing Address - Street 1:7522 FORT GRIFFEN DR
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-5763
Mailing Address - Country:US
Mailing Address - Phone:361-563-7378
Mailing Address - Fax:
Practice Address - Street 1:3535 S. ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78410-7841
Practice Address - Country:US
Practice Address - Phone:361-694-4245
Practice Address - Fax:361-694-6816
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX736583163WF0300X
TX1055526363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WF0300XNursing Service ProvidersRegistered NurseFlight