Provider Demographics
NPI:1356785448
Name:HUERTA, IRENE RAQUEL (WHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:RAQUEL
Last Name:HUERTA
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7121 S PADRE ISLAND DR STE 100
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78412-4939
Mailing Address - Country:US
Mailing Address - Phone:361-993-6000
Mailing Address - Fax:361-993-0266
Practice Address - Street 1:7121 S PADRE ISLAND DR STE 100
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78412-4939
Practice Address - Country:US
Practice Address - Phone:361-993-6000
Practice Address - Fax:361-993-0266
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP122238363LW0102X
TX678886364SW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No364SW0102XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX329976003Medicaid
TXAP122238OtherTX BOARD OF NURSING - WOMEN'S HEALTH NURSE PRACTITIONER
104322768OtherNATIONAL CERTIFICATION CORPORATION - WHNP-BC
104322768OtherNATIONAL CERTIFICATION CORPORATION - WHNP-BC