Provider Demographics
NPI:1457363020
Name:DE LA ROSA, YOLANDA LOPEZ (FNP-C)
Entity type:Individual
Prefix:
First Name:YOLANDA
Middle Name:LOPEZ
Last Name:DE LA ROSA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:YOLANDA
Other - Middle Name:
Other - Last Name:LOPEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:950 N 14TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1111
Mailing Address - Country:US
Mailing Address - Phone:409-833-5858
Mailing Address - Fax:409-833-1155
Practice Address - Street 1:950 N 14TH ST STE 100
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1112
Practice Address - Country:US
Practice Address - Phone:409-833-5858
Practice Address - Fax:409-833-1155
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236917363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX236917OtherNURSE PRACTITIONERS
TX352248401Medicaid