Provider Demographics
NPI:1538396924
Name:CARRILLO BLANCO, BEATRIZ (DNP, FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:MRS
First Name:BEATRIZ
Middle Name:
Last Name:CARRILLO BLANCO
Suffix:
Gender:F
Credentials:DNP, FNP-C, PMHNP-BC
Other - Prefix:MRS
Other - First Name:BEATRIZ
Other - Middle Name:
Other - Last Name:CARRILLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-C, PMHNP-BC
Mailing Address - Street 1:1605 GEORGE DIETER DR STE 636
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79936-5692
Mailing Address - Country:US
Mailing Address - Phone:915-671-1371
Mailing Address - Fax:915-219-9022
Practice Address - Street 1:1390 NORTHWESTERN DR
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-8003
Practice Address - Country:US
Practice Address - Phone:915-671-1371
Practice Address - Fax:915-219-9022
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113106363LP0808X, 363LF0000X
TX658407163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1538396924OtherNPI
TX1629273305Medicare PIN
TXG53956Medicare UPIN
TX1376585489Medicare PIN
TX130880107OtherMEDICAID GROUP
TX130880104OtherGROUP MEDICAID