Provider Demographics
NPI:1821759432
Name:CANTU, ELVA (NP)
Entity Type:Individual
Prefix:
First Name:ELVA
Middle Name:
Last Name:CANTU
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 1:301 HOLLEMAN DR E APT 1117
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-7049
Mailing Address - Country:US
Mailing Address - Phone:512-939-9014
Mailing Address - Fax:
Practice Address - Street 1:301 HOLLEMAN DR E APT 1117
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-7049
Practice Address - Country:US
Practice Address - Phone:512-939-9014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-05
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1059131363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology