Provider Demographics
NPI:1699284075
Name:AMORUSO, NICOLA SIOBHAN (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLA
Middle Name:SIOBHAN
Last Name:AMORUSO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:NICOLA
Other - Middle Name:SIOBHAN
Other - Last Name:LOONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6400 FANNIN ST STE 1700
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-1526
Mailing Address - Country:US
Mailing Address - Phone:713-486-1700
Mailing Address - Fax:713-467-6682
Practice Address - Street 1:950 CORBINDALE RD STE 300
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77024-2849
Practice Address - Country:US
Practice Address - Phone:713-486-1700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2023-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTEMP363A00000X
390200000X
TXPA11530363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program