Provider Demographics
NPI:1811556319
Name:SIFUENTES, LINDA (NP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:
Last Name:SIFUENTES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S MAIN ST STE 119
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-5577
Mailing Address - Country:US
Mailing Address - Phone:817-576-6665
Mailing Address - Fax:817-576-6663
Practice Address - Street 1:1111 S MAIN ST STE 119
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-5577
Practice Address - Country:US
Practice Address - Phone:817-576-6665
Practice Address - Fax:817-576-6663
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-07
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139151363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily