Individual
SOLEIMA DALLANA MANTILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
1900 MATLOCK RD STE 804, MANSFIELD, TX 76063-4455
(682) 800-3211
Mailing address
1900 MATLOCK RD STE 804, MANSFIELD, TX 76063-4455
(682) 800-3211
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
1093926
TX
363LG0600X
Gerontology Nurse Practitioner
Primary
1093926
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45220
TEXAS BOARD OF NURSING
TX
Enumeration date
12/12/2022
Last updated
07/05/2023
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