Individual
MRS. MARIAELENA ELEANORA TICE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN, CPNP
Contact information
Practice address
C THOMAS MOORE HEALTH CLINIC, 56TH AND 761ST BATTALION AVE BUILDING 2245, FORT HOOD, TX 76544-4752
(254) 553-2750
(254) 285-6193
Mailing address
4777 GUB CLUB ROAD, TEMPLE, TX 76501
(254) 553-2750
(254) 285-6193
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
449918
TX
Other
Enumeration date
06/13/2006
Last updated
07/08/2007
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