Provider Demographics
NPI:1861675753
Name:ENRIQUEZ, SUSANA C (RN FNPC)
Entity Type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:C
Last Name:ENRIQUEZ
Suffix:
Gender:F
Credentials:RN FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 E MAIN
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332
Mailing Address - Country:US
Mailing Address - Phone:361-661-8000
Mailing Address - Fax:361-661-8073
Practice Address - Street 1:123 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:FREER
Practice Address - State:TX
Practice Address - Zip Code:78357
Practice Address - Country:US
Practice Address - Phone:361-394-7311
Practice Address - Fax:361-394-7158
Is Sole Proprietor?:No
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0807232363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily