Provider Demographics
NPI:1518605237
Name:EUSEBIO, JOHN (FNP-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:EUSEBIO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:JOHN MICHAEL FRANCIS
Other - Middle Name:
Other - Last Name:EUSEBIO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:6355 S BUFFALO DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2133
Mailing Address - Country:US
Mailing Address - Phone:702-216-3346
Mailing Address - Fax:702-869-8103
Practice Address - Street 1:2650 N TENAYA WAY STE 201
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1110
Practice Address - Country:US
Practice Address - Phone:702-735-7154
Practice Address - Fax:702-869-8103
Is Sole Proprietor?:No
Enumeration Date:2022-05-23
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV884184363LF0000X
CA95020261363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV884184OtherSTATE LICENSE
NV1518605237Medicaid