Provider Demographics
NPI:1699067504
Name:HERRERA, ELIAMAR (PNP)
Entity type:Individual
Prefix:MRS
First Name:ELIAMAR
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:517 TAMARA DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-8828
Mailing Address - Country:US
Mailing Address - Phone:512-863-4925
Mailing Address - Fax:
Practice Address - Street 1:517 TAMARA DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-8828
Practice Address - Country:US
Practice Address - Phone:512-863-4925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX231719363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics