Provider Demographics
NPI:1205651676
Name:FLORES, BRENDA LIZETH (FNP)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:LIZETH
Last Name:FLORES
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 1:1405 JACAMAN RD STE 104
Mailing Address - Street 2:
Mailing Address - City:LAREDO
Mailing Address - State:TX
Mailing Address - Zip Code:78041-6225
Mailing Address - Country:US
Mailing Address - Phone:956-727-3047
Mailing Address - Fax:356-717-3630
Practice Address - Street 1:1405 JACAMAN RD STE 104
Practice Address - Street 2:
Practice Address - City:LAREDO
Practice Address - State:TX
Practice Address - Zip Code:78041-6225
Practice Address - Country:US
Practice Address - Phone:956-727-3047
Practice Address - Fax:356-717-3630
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-20
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1180168363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily