Provider Demographics
NPI:1851739700
Name:CANTU, LETICIA R (FNP)
Entity Type:Individual
Prefix:MRS
First Name:LETICIA
Middle Name:R
Last Name:CANTU
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4430 E 14TH ST
Mailing Address - Street 2:STE. A
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78521-3363
Mailing Address - Country:US
Mailing Address - Phone:956-544-5557
Mailing Address - Fax:956-544-5100
Practice Address - Street 1:4430 E 14TH ST
Practice Address - Street 2:STE. A
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-3363
Practice Address - Country:US
Practice Address - Phone:956-544-5557
Practice Address - Fax:956-544-5100
Is Sole Proprietor?:No
Enumeration Date:2013-06-12
Last Update Date:2013-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX606093363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily