Provider Demographics
NPI:1548131626
Name:HALL, GUSTAVIA RENEE (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:GUSTAVIA
Middle Name:RENEE
Last Name:HALL
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9642 RIDDLEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-5005
Mailing Address - Country:US
Mailing Address - Phone:832-545-2420
Mailing Address - Fax:
Practice Address - Street 1:9642 RIDDLEWOOD LN
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77025-5005
Practice Address - Country:US
Practice Address - Phone:832-545-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-13
Last Update Date:2025-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX836882163W00000X
CA95116191163W00000X
TXF07250211363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty