Provider Demographics
NPI:1053044818
Name:DELGADO, NICOLE SOFIA (PA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:SOFIA
Last Name:DELGADO
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7122 WOOD HOLLOW DR APT 35
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-2545
Mailing Address - Country:US
Mailing Address - Phone:210-548-1165
Mailing Address - Fax:
Practice Address - Street 1:7011 RIBELIN RANCH RD STE 200
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-8585
Practice Address - Country:US
Practice Address - Phone:512-345-7436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-07
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA17513363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant