Provider Demographics
NPI:1013591569
Name:FLOYD, SOVANNARAT (FNP-BC)
Entity Type:Individual
Prefix:
First Name:SOVANNARAT
Middle Name:
Last Name:FLOYD
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 N LAMAR BLVD
Mailing Address - Street 2:STE 200A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78753-5976
Mailing Address - Country:US
Mailing Address - Phone:512-782-9312
Mailing Address - Fax:512-782-9316
Practice Address - Street 1:906 W MCDERMOTT DR STE 124
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-5424
Practice Address - Country:US
Practice Address - Phone:469-564-1026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1034953207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine