Basic Information
| Provider Information | |||||||||
| NPI: | 1043935729 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FLORES | ||||||||
| FirstName: | GEORGETTE | ||||||||
| MiddleName: | NICOLE | ||||||||
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| Credential: | CRNA, APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5415 S MCCOLL RD | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785399183 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9566610529 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5501 S MCCOLL RD | ||||||||
| Address2: | |||||||||
| City: | EDINBURG | ||||||||
| State: | TX | ||||||||
| PostalCode: | 785395503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9563628677 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2022 | ||||||||
| LastUpdateDate: | 10/05/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 10/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 1096012 | TX | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
No ID Information.