Provider Demographics
NPI:1306678685
Name:AVILES, RENEE (NP)
Entity type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:AVILES
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7205 FORESTWIND CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76001-4843
Mailing Address - Country:US
Mailing Address - Phone:318-560-2884
Mailing Address - Fax:
Practice Address - Street 1:6320 SOUTHWEST BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BENBROOK
Practice Address - State:TX
Practice Address - Zip Code:76109-6961
Practice Address - Country:US
Practice Address - Phone:817-766-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-15
Last Update Date:2024-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1138075363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner