Provider Demographics
NPI:1528634649
Name:CAMPOS, GERALDINE TAER (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:GERALDINE
Middle Name:TAER
Last Name:CAMPOS
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7915 FM 1960 RD W STE 122
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5716
Mailing Address - Country:US
Mailing Address - Phone:678-739-1879
Mailing Address - Fax:
Practice Address - Street 1:7915 FM 1960 RD W STE 122
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5716
Practice Address - Country:US
Practice Address - Phone:832-245-4816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-30
Last Update Date:2021-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029214363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care