Provider Demographics
NPI:1801529540
Name:FORD, ILANA ROSE (FNP-BC)
Entity type:Individual
Prefix:
First Name:ILANA
Middle Name:ROSE
Last Name:FORD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:ILANA
Other - Middle Name:
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:15835 TAYDEN POINT DR
Mailing Address - Street 2:
Mailing Address - City:HUMBLE
Mailing Address - State:TX
Mailing Address - Zip Code:77346-4357
Mailing Address - Country:US
Mailing Address - Phone:845-325-8505
Mailing Address - Fax:
Practice Address - Street 1:15835 TAYDEN POINT DR
Practice Address - Street 2:
Practice Address - City:HUMBLE
Practice Address - State:TX
Practice Address - Zip Code:77346-4357
Practice Address - Country:US
Practice Address - Phone:845-325-8505
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-08
Last Update Date:2024-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017535363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily