Provider Demographics
NPI:1730608191
Name:BOVAN, AUDRINA CATHLEEN (AGACNP)
Entity type:Individual
Prefix:MRS
First Name:AUDRINA
Middle Name:CATHLEEN
Last Name:BOVAN
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:MS
Other - First Name:AUDRINA
Other - Middle Name:CATHLEEN
Other - Last Name:HUANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4532 N MESA ST
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-6286
Mailing Address - Country:US
Mailing Address - Phone:915-247-3150
Mailing Address - Fax:
Practice Address - Street 1:4532 N MESA ST
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-6286
Practice Address - Country:US
Practice Address - Phone:915-247-3150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2017-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX785666363LA2100X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology