Basic Information
| Provider Information | |||||||||
| NPI: | 1609348119 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FLORES | ||||||||
| FirstName: | DENELL | ||||||||
| MiddleName: | DAWN | ||||||||
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| Credential: | FNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4601 NE COUNTY ROAD 1040 | ||||||||
| Address2: | |||||||||
| City: | RICE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751555123 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036416585 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3124 W HIGHWAY 22 | ||||||||
| Address2: | |||||||||
| City: | CORSICANA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 751102435 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9036414270 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2018 | ||||||||
| LastUpdateDate: | 09/11/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | AP139743 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.