Provider Demographics
NPI:1942783410
Name:DERUPE, MAYRA (FNP)
Entity Type:Individual
Prefix:
First Name:MAYRA
Middle Name:
Last Name:DERUPE
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 1:910 S BRYAN RD STE 209
Mailing Address - Street 2:
Mailing Address - City:MISSION
Mailing Address - State:TX
Mailing Address - Zip Code:78572-6659
Mailing Address - Country:US
Mailing Address - Phone:956-424-1511
Mailing Address - Fax:
Practice Address - Street 1:910 S BRYAN RD STE 209
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:TX
Practice Address - Zip Code:78572-6659
Practice Address - Country:US
Practice Address - Phone:956-424-1511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-11
Last Update Date:2018-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP138577363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care