Provider Demographics
NPI:1174094486
Name:CANLAPAN, GRACE PARAM (FNP)
Entity type:Individual
Prefix:MRS
First Name:GRACE
Middle Name:PARAM
Last Name:CANLAPAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:MONTEMAYOR
Other - Last Name:PARAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4502 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-4402
Mailing Address - Country:US
Mailing Address - Phone:210-358-4000
Mailing Address - Fax:210-450-4903
Practice Address - Street 1:4502 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229-4402
Practice Address - Country:US
Practice Address - Phone:210-358-4000
Practice Address - Fax:210-450-4903
Is Sole Proprietor?:No
Enumeration Date:2018-12-13
Last Update Date:2019-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139552363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX396606101Medicaid
TX396606102OtherCSHCN