Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Itasca Healing Medical Practice

Organization Nurse Practitioner · NPI 1023867546

Itasca Healing Medical Practice is a Nurse Practitioner in Nacogdoches, Texas. Registered with an NPI since 2024.

In the registry since
2024

Practice location Address checks out

223 King St
Nacogdoches, TX 75961-4421
Phone: (936) 622-0552
Fax: (936) 622-0554
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Nurse Practitioner (primary) Taxonomy 363L00000X

Record details

NPI number1023867546
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Suzanna Fuller — Owner/ Provider · (936) 622-0552
NPI enumeratedMay 16, 2024
Last updated in NPPESAugust 5, 2026
Certification dateAugust 5, 2026
Mailing address223 King St, Nacogdoches, TX 75961-4421

Other providers in Nacogdoches