Provider Demographics
NPI:1144814799
Name:MIRASOL, MA LUISA CHUA (FNP-C)
Entity type:Individual
Prefix:
First Name:MA LUISA
Middle Name:CHUA
Last Name:MIRASOL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MA. LUISA
Other - Middle Name:ROSARIO
Other - Last Name:CHUA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:5616 DURST LN
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-1937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5616 DURST LN
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-1937
Practice Address - Country:US
Practice Address - Phone:469-432-7772
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-24
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1030515363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily