Provider Demographics
NPI:1053961888
Name:SURESH, ASHA (APRN)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:
Last Name:SURESH
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:ASHA
Other - Middle Name:
Other - Last Name:VARGHESE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3117 BLUE RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-1128
Mailing Address - Country:US
Mailing Address - Phone:512-514-4007
Mailing Address - Fax:
Practice Address - Street 1:3901A SPICEWOOD SPRINGS RD STE 201
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8728
Practice Address - Country:US
Practice Address - Phone:737-226-6713
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-13
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP141852363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily