Provider Demographics
NPI:1821499682
Name:FREEMAN, FRAQUANIA TALESH (APRN)
Entity Type:Individual
Prefix:
First Name:FRAQUANIA
Middle Name:TALESH
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 S FLEISHEL AVE
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75702-8413
Mailing Address - Country:US
Mailing Address - Phone:903-526-7055
Mailing Address - Fax:903-593-4303
Practice Address - Street 1:505 S FLEISHEL AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8413
Practice Address - Country:US
Practice Address - Phone:903-526-7055
Practice Address - Fax:903-593-4303
Is Sole Proprietor?:No
Enumeration Date:2014-09-11
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126467363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care