Provider Demographics
NPI:1184137333
Name:ESTRADA, AIIESA GABRIELA (FNP-C)
Entity type:Individual
Prefix:MRS
First Name:AIIESA
Middle Name:GABRIELA
Last Name:ESTRADA
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 1:1373 SPRINGFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210-3754
Mailing Address - Country:US
Mailing Address - Phone:520-234-0169
Mailing Address - Fax:
Practice Address - Street 1:1702 W GILCHRIST AVE
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210-1100
Practice Address - Country:US
Practice Address - Phone:575-513-7696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-09
Last Update Date:2024-06-24
Deactivation Date:2018-01-19
Deactivation Code:
Reactivation Date:2018-01-31
Provider Licenses
StateLicense IDTaxonomies
NM63928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily