Provider Demographics
NPI:1164790853
Name:VASTINE, PAULA (FNP)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:VASTINE
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:PROF
Other - First Name:PAULA
Other - Middle Name:
Other - Last Name:VASTINE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP
Mailing Address - Street 1:11797 SOUTH FWY STE 338
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-7035
Mailing Address - Country:US
Mailing Address - Phone:817-568-5485
Mailing Address - Fax:817-568-5434
Practice Address - Street 1:11797 SOUTH FWY STE 338
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-7035
Practice Address - Country:US
Practice Address - Phone:817-568-5485
Practice Address - Fax:817-568-5434
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-23536164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2-23536OtherTEXAS STATE LICENSING BOARD