Provider Demographics
NPI:1023630977
Name:SALCEDO, ANDREA ELOISA (ACAGNP-BC RN)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:ELOISA
Last Name:SALCEDO
Suffix:
Gender:F
Credentials:ACAGNP-BC RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11428 LAKE NEMI DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-3953
Mailing Address - Country:US
Mailing Address - Phone:915-433-7649
Mailing Address - Fax:
Practice Address - Street 1:1205 N OREGON ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-4023
Practice Address - Country:US
Practice Address - Phone:915-533-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-14
Last Update Date:2020-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP1455945363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care