Provider Demographics
NPI:1902339930
Name:PORRAS, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:PORRAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:OBINA
Other - Last Name:TEOFISTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:314 BREEZEWAY AVE
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78404-1750
Mailing Address - Country:US
Mailing Address - Phone:361-960-8205
Mailing Address - Fax:
Practice Address - Street 1:314 BREEZEWAY AVE
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78404-1750
Practice Address - Country:US
Practice Address - Phone:361-960-8205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX565198163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse