Provider Demographics
NPI:1902212012
Name:HERRERA, AMY (CST CSFA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:CST CSFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 COMMERCE ST APT 1605
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75202-4358
Mailing Address - Country:US
Mailing Address - Phone:972-704-8496
Mailing Address - Fax:
Practice Address - Street 1:1222 COMMERCE ST APT 1605
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75202-4358
Practice Address - Country:US
Practice Address - Phone:972-704-8496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-09
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX148588364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical