Provider Demographics
NPI:1780159897
Name:TRIANGLE SPECIALIZED FAMILY CLINIC
Entity type:Organization
Organization Name:TRIANGLE SPECIALIZED FAMILY CLINIC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EFEHI
Authorized Official - Middle Name:HENRIETTA
Authorized Official - Last Name:ENOBAKHARE
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:956-561-1461
Mailing Address - Street 1:1013 CHAMPLAIN DR
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78526-1245
Mailing Address - Country:US
Mailing Address - Phone:956-561-1461
Mailing Address - Fax:956-621-4537
Practice Address - Street 1:1805 E RUBEN M TORRES BLVD
Practice Address - Street 2:SUITE A-3
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78526
Practice Address - Country:US
Practice Address - Phone:866-446-9620
Practice Address - Fax:956-267-5255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-05
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty