Provider Demographics
NPI:1174158604
Name:ESTABILLO, EDSEL (MSN,APRN,FNP-C,CEN)
Entity type:Individual
Prefix:MRS
First Name:EDSEL
Middle Name:
Last Name:ESTABILLO
Suffix:
Gender:F
Credentials:MSN,APRN,FNP-C,CEN
Other - Prefix:MRS
Other - First Name:EDSEL
Other - Middle Name:NOVAL
Other - Last Name:ESTABILLO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSN,APRN,FNP-C,CEN
Mailing Address - Street 1:22327 SHELDONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77449-5387
Mailing Address - Country:US
Mailing Address - Phone:732-814-3009
Mailing Address - Fax:
Practice Address - Street 1:104 7TH ST
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:TX
Practice Address - Zip Code:77414-4853
Practice Address - Country:US
Practice Address - Phone:979-245-6383
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-05
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145173363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner