Provider Demographics
NPI:1104326784
Name:ONTITA, EUNICE B (APRN)
Entity type:Individual
Prefix:MS
First Name:EUNICE
Middle Name:B
Last Name:ONTITA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3635 BROADWAY BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-1647
Mailing Address - Country:US
Mailing Address - Phone:972-787-0060
Mailing Address - Fax:972-722-3208
Practice Address - Street 1:3635 BROADWAY BLVD STE A
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-1647
Practice Address - Country:US
Practice Address - Phone:972-787-0060
Practice Address - Fax:972-722-3208
Is Sole Proprietor?:No
Enumeration Date:2018-02-20
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAPR136283363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health