Provider Demographics
NPI:1962035337
Name:DERAS, BOBBI EUGENIA (NP)
Entity Type:Individual
Prefix:
First Name:BOBBI
Middle Name:EUGENIA
Last Name:DERAS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 N MESA ST STE B
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-1124
Mailing Address - Country:US
Mailing Address - Phone:915-779-7378
Mailing Address - Fax:915-779-2822
Practice Address - Street 1:4305 N MESA ST STE B
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-1124
Practice Address - Country:US
Practice Address - Phone:915-779-7378
Practice Address - Fax:915-779-2822
Is Sole Proprietor?:No
Enumeration Date:2020-02-13
Last Update Date:2020-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145764363LG0600X
TX788601363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology