Provider Demographics
NPI:1285713180
Name:GARCIA, IRIS E (RN PNP)
Entity type:Individual
Prefix:MRS
First Name:IRIS
Middle Name:E
Last Name:GARCIA
Suffix:
Gender:F
Credentials:RN PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:410 S. BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELSA
Mailing Address - State:TX
Mailing Address - Zip Code:78543
Mailing Address - Country:US
Mailing Address - Phone:956-262-9805
Mailing Address - Fax:956-262-9233
Practice Address - Street 1:410 S. BROADWAY
Practice Address - Street 2:
Practice Address - City:ELSA
Practice Address - State:TX
Practice Address - Zip Code:78543
Practice Address - Country:US
Practice Address - Phone:956-262-9805
Practice Address - Fax:956-262-9233
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX220041063171M00000X
TX533197363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX173560701OtherMEDICAID GROUP
TX121084101Medicaid
TX74214OtherTML IEBP
TX80314OtherUNICARE
TX8N86548OtherBLUE CROSS BLUE SHIELD
TX121084102OtherHEALTH STEP
TX121392OtherSUPERIOR HEALTH PLAN