Provider Demographics
NPI:1447948138
Name:FLORENCE BANKSTON, DESTANIE (FNP)
Entity type:Individual
Prefix:MS
First Name:DESTANIE
Middle Name:
Last Name:FLORENCE BANKSTON
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 SPLINTERED ARROW DR
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-6621
Mailing Address - Country:US
Mailing Address - Phone:409-354-3411
Mailing Address - Fax:
Practice Address - Street 1:227 SPLINTERED ARROW DR
Practice Address - Street 2:
Practice Address - City:LA MARQUE
Practice Address - State:TX
Practice Address - Zip Code:77568-6621
Practice Address - Country:US
Practice Address - Phone:409-354-3411
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1111673363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily