Provider Demographics
NPI:1417570003
Name:DESIRE TO LIVE NOW, LLC
Entity type:Organization
Organization Name:DESIRE TO LIVE NOW, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:SUSANNE
Authorized Official - Last Name:MIXON
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-C
Authorized Official - Phone:512-643-3631
Mailing Address - Street 1:790 GENERATIONS DR STE 210
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-0087
Mailing Address - Country:US
Mailing Address - Phone:512-643-3631
Mailing Address - Fax:512-265-9692
Practice Address - Street 1:790 GENERATIONS DR STE 210
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-0087
Practice Address - Country:US
Practice Address - Phone:512-643-3631
Practice Address - Fax:512-265-9692
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-18
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily