Provider Demographics
NPI:1316630239
Name:PEASE, BIANCA ALICIA JACLYN (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:BIANCA
Middle Name:ALICIA JACLYN
Last Name:PEASE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MS
Other - First Name:BIANCA
Other - Middle Name:ALICIA JACLYN
Other - Last Name:ROSALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:12576 TWIN LEAF DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79928-5837
Mailing Address - Country:US
Mailing Address - Phone:915-867-6252
Mailing Address - Fax:
Practice Address - Street 1:8623 N LOOP DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79907-4520
Practice Address - Country:US
Practice Address - Phone:915-881-4155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-26
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1123563363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily