Provider Demographics
NPI:1700163748
Name:BRAVO, ELIZABETH HEREDIA (MSN, RN, CPNP)
Entity Type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:HEREDIA
Last Name:BRAVO
Suffix:
Gender:F
Credentials:MSN, RN, CPNP
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Mailing Address - Street 1:4659 COHEN AVE UNIT C
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4430
Mailing Address - Country:US
Mailing Address - Phone:915-751-1152
Mailing Address - Fax:
Practice Address - Street 1:4659 COHEN AVE UNIT C
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-4430
Practice Address - Country:US
Practice Address - Phone:915-751-1152
Practice Address - Fax:800-599-1574
Is Sole Proprietor?:No
Enumeration Date:2011-11-04
Last Update Date:2023-12-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TX719183363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics