Provider Demographics
NPI:1174875025
Name:HERRERA, GLORIA (APN)
Entity type:Individual
Prefix:
First Name:GLORIA
Middle Name:
Last Name:HERRERA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12730 IH 10 W
Mailing Address - Street 2:SUITE 306
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1003
Mailing Address - Country:US
Mailing Address - Phone:210-877-0772
Mailing Address - Fax:210-877-0785
Practice Address - Street 1:12730 IH 10 W
Practice Address - Street 2:SUITE 306
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1003
Practice Address - Country:US
Practice Address - Phone:210-877-0772
Practice Address - Fax:210-877-0785
Is Sole Proprietor?:No
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX624838363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily