Provider Demographics
NPI:1003229386
Name:BULLOCK, ANNA (NNP)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6401 LLANO STAGE TRL
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78738-6199
Mailing Address - Country:US
Mailing Address - Phone:512-923-1509
Mailing Address - Fax:
Practice Address - Street 1:2609 BLAKE ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78748-3950
Practice Address - Country:US
Practice Address - Phone:512-923-1509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP126653363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal