Individual
GOLDEN EAGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
333 N SANTA ROSA, SAN ANTONIO, TX 78207-3108
(210) 704-3030
Mailing address
14041 NORTHWEST BLVD STE 1, CORPUS CHRISTI, TX 78410-5138
(361) 767-9963
(361) 767-8477
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
777367
TX
363L00000X
Nurse Practitioner
Primary
AP129167
TX
363LP0200X
Pediatric Nurse Practitioner
777367
TX
363LP0200X
Pediatric Nurse Practitioner
AP129167
TX
Other
Enumeration date
10/06/2015
Last updated
03/08/2024
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