Provider Demographics
NPI:1013591569
Name:FLOYD, SOVANNARAT (FNP)
Entity type:Individual
Prefix:
First Name:SOVANNARAT
Middle Name:
Last Name:FLOYD
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 1:2698 N GALLOWAY AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75150-6387
Mailing Address - Country:US
Mailing Address - Phone:800-218-8989
Mailing Address - Fax:
Practice Address - Street 1:2698 N GALLOWAY AVE STE 105
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75150-6387
Practice Address - Country:US
Practice Address - Phone:469-564-1026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2024-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034953363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily