Provider Demographics
NPI:1871033290
Name:PROMENADE HEALTHCARE, PLLC
Entity Type:Organization
Organization Name:PROMENADE HEALTHCARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AZIZI
Authorized Official - Middle Name:SHANI
Authorized Official - Last Name:JOHNSON-AUBERT
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:832-250-7007
Mailing Address - Street 1:2611 CYPRESS CREEK PKWY STE B100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77068-3730
Mailing Address - Country:US
Mailing Address - Phone:713-904-5150
Mailing Address - Fax:713-955-9698
Practice Address - Street 1:2611 CYPRESS CREEK PKWY STE B100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77068-3730
Practice Address - Country:US
Practice Address - Phone:713-904-5150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-04
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0050X, 261QP2300X
TX702507363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-SurgicalGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty