Provider Demographics
NPI:1831657550
Name:GAMBOA, PRISCILLA (AGACNP)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:GAMBOA
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19823 RINGWALD CT
Mailing Address - Street 2:
Mailing Address - City:SPRING
Mailing Address - State:TX
Mailing Address - Zip Code:77379-5059
Mailing Address - Country:US
Mailing Address - Phone:713-425-9249
Mailing Address - Fax:
Practice Address - Street 1:10837 KATY FWY STE 250
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77079-2205
Practice Address - Country:US
Practice Address - Phone:713-464-8099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX785168363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care