Provider Demographics
NPI:1982141677
Name:GARZA, PENNY M (RN-FNP)
Entity Type:Individual
Prefix:MRS
First Name:PENNY
Middle Name:M
Last Name:GARZA
Suffix:
Gender:F
Credentials:RN-FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1470
Mailing Address - Street 2:
Mailing Address - City:EAGLE PASS
Mailing Address - State:TX
Mailing Address - Zip Code:78853-1470
Mailing Address - Country:US
Mailing Address - Phone:830-773-8917
Mailing Address - Fax:830-773-1892
Practice Address - Street 1:2525 N VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:EAGLE PASS
Practice Address - State:TX
Practice Address - Zip Code:78852-3302
Practice Address - Country:US
Practice Address - Phone:830-773-5358
Practice Address - Fax:830-773-0258
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-19
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP133019363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2016025869OtherAMERICAN NURSE CREDENTIALING CENTER
TXAPRN LIC.#: AP133019OtherFAMILY NURSE PRACTITIONER
TX3762486-01Medicaid