Provider Demographics
NPI:1750767364
Name:CAYSIE N GARZA APRN FNP-C LLC
Entity type:Organization
Organization Name:CAYSIE N GARZA APRN FNP-C LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAYSIE
Authorized Official - Middle Name:N
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:APRN, FNP-C
Authorized Official - Phone:918-687-5477
Mailing Address - Street 1:3401 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-2136
Mailing Address - Country:US
Mailing Address - Phone:918-687-5477
Mailing Address - Fax:918-681-1392
Practice Address - Street 1:3401 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-2136
Practice Address - Country:US
Practice Address - Phone:918-687-5477
Practice Address - Fax:918-681-1392
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK93131305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization