Provider Demographics
NPI:1033864665
Name:PRINCE, DEBORAH KATHARINE (FNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KATHARINE
Last Name:PRINCE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 WICKERSHAM LN APT 1085
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-3132
Mailing Address - Country:US
Mailing Address - Phone:512-619-5228
Mailing Address - Fax:
Practice Address - Street 1:3614 BILL PRICE RD
Practice Address - Street 2:
Practice Address - City:DEL VALLE
Practice Address - State:TX
Practice Address - Zip Code:78617-3630
Practice Address - Country:US
Practice Address - Phone:512-854-4193
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-11
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1057694363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily