Provider Demographics
NPI:1366149684
Name:GRACIA, ENEDINA (FNP-C)
Entity type:Individual
Prefix:
First Name:ENEDINA
Middle Name:
Last Name:GRACIA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2210 W MARLAND ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-8641
Mailing Address - Country:US
Mailing Address - Phone:575-441-3103
Mailing Address - Fax:
Practice Address - Street 1:5419 N LOVINGTON HWY STE 1
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9102
Practice Address - Country:US
Practice Address - Phone:575-392-1503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-08
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM71864363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily