Provider Demographics
NPI:1790111482
Name:HERRERA, IDA GAIL (NP)
Entity Type:Individual
Prefix:
First Name:IDA
Middle Name:GAIL
Last Name:HERRERA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:IDA
Other - Middle Name:GAIL
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:80 MCMAKIN RD
Mailing Address - Street 2:
Mailing Address - City:BARTONVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-8438
Mailing Address - Country:US
Mailing Address - Phone:940-455-7100
Mailing Address - Fax:940-455-7105
Practice Address - Street 1:80 MCMAKIN RD
Practice Address - Street 2:
Practice Address - City:BARTONVILLE
Practice Address - State:TX
Practice Address - Zip Code:76226-8438
Practice Address - Country:US
Practice Address - Phone:940-455-7100
Practice Address - Fax:940-455-7105
Is Sole Proprietor?:No
Enumeration Date:2013-09-25
Last Update Date:2022-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX630172163W00000X
TXAP124490363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse