Provider Demographics
NPI:1487264198
Name:TELLEZ, VENESSA JEAN (FNP-C)
Entity type:Individual
Prefix:
First Name:VENESSA
Middle Name:JEAN
Last Name:TELLEZ
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 WALDEN POND ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-2407
Mailing Address - Country:US
Mailing Address - Phone:915-217-4665
Mailing Address - Fax:
Practice Address - Street 1:10800 WALDEN POND ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924-2407
Practice Address - Country:US
Practice Address - Phone:915-217-4665
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-06
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1007040363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily