Provider Demographics
NPI:1942753629
Name:GUERRA, BLANCA L (FNP-C)
Entity Type:Individual
Prefix:
First Name:BLANCA
Middle Name:L
Last Name:GUERRA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2013 E GRIFFIN PKWY
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-3222
Mailing Address - Country:US
Mailing Address - Phone:956-585-4704
Mailing Address - Fax:
Practice Address - Street 1:1701 S CAGE BLVD STE 116
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-6459
Practice Address - Country:US
Practice Address - Phone:956-702-7054
Practice Address - Fax:956-702-7650
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-28
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131332363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX368112401Medicaid