Provider Demographics
NPI:1023287653
Name:FLORES, MANUEL R (FNP)
Entity type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:R
Last Name:FLORES
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1620 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SPANISH FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84660-1008
Mailing Address - Country:US
Mailing Address - Phone:435-559-1008
Mailing Address - Fax:866-913-0013
Practice Address - Street 1:34910 INTERSTATE 10 W STE 301
Practice Address - Street 2:
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-9230
Practice Address - Country:US
Practice Address - Phone:210-202-0250
Practice Address - Fax:866-546-3513
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX687932363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX687932OtherSTATE LICENSE