Provider Demographics
NPI:1366772857
Name:LAND, AVA J (RN, MSN, FNP)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:J
Last Name:LAND
Suffix:
Gender:F
Credentials:RN, MSN, FNP
Other - Prefix:
Other - First Name:AVA
Other - Middle Name:JO
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:3517 SW WILSHIRE BLVD
Mailing Address - Street 2:
Mailing Address - City:JOSHUA
Mailing Address - State:TX
Mailing Address - Zip Code:76058-6159
Mailing Address - Country:US
Mailing Address - Phone:817-447-1151
Mailing Address - Fax:817-529-8927
Practice Address - Street 1:3517 SW WILSHIRE BLVD
Practice Address - Street 2:
Practice Address - City:JOSHUA
Practice Address - State:TX
Practice Address - Zip Code:76058-6159
Practice Address - Country:US
Practice Address - Phone:817-447-1151
Practice Address - Fax:817-529-8927
Is Sole Proprietor?:No
Enumeration Date:2010-01-05
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP107430363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX564297OtherLICENSE