Organization
EL PASO ADVANCE PRACTICE PROVIDER, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARON TARAY PEEBLES ANP (CEO)
(915) 532-2477
Entity
Organization
Contact information
Practice address
5080 POWDER RIVER LN, EL PASO, TX 79938-8286
(915) 328-2311
Mailing address
1605 GEORGE DIETER DR STE 636, EL PASO, TX 79936-5600
(915) 671-1371
(915) 219-9022
Taxonomy
Speciality
Code
Description
License number
State
343800000X
Secured Medical Transport (VAN)
—
—
363LA2100X
Acute Care Nurse Practitioner
Primary
121725
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1437423696
—
TX
Enumeration date
02/01/2018
Last updated
06/06/2024
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