Basic Information
| Provider Information | |||||||||
| NPI: | 1134600059 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SERNA | ||||||||
| FirstName: | CELINA | ||||||||
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| Credential: | NURSE PRACTITIONER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4052 FM 2782 | ||||||||
| Address2: | |||||||||
| City: | NACOGDOCHES | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759645255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9365563615 | ||||||||
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| Practice Location | |||||||||
| Address1: | 507 JACOB ST | ||||||||
| Address2: | |||||||||
| City: | TIMPSON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 759755255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9362543338 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2018 | ||||||||
| LastUpdateDate: | 08/28/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP2300X | AP138153 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 163W00000X | 725235 | TX | Y | Nursing Service Providers | Registered Nurse |
No ID Information.