Provider Demographics
NPI:1528126034
Name:HIDALGO, SUSAN (FNP)
Entity type:Individual
Prefix:MISS
First Name:SUSAN
Middle Name:
Last Name:HIDALGO
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6510 FOLSOM DR
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-7274
Mailing Address - Country:US
Mailing Address - Phone:409-832-6545
Mailing Address - Fax:409-832-7494
Practice Address - Street 1:6510 FOLSOM DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-7274
Practice Address - Country:US
Practice Address - Phone:409-832-6545
Practice Address - Fax:409-832-7494
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2010-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX595117363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX595117OtherSTATE LICENSED