Provider Demographics
NPI:1225374598
Name:BURBANK, NICOLE LYNN (PCT)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNN
Last Name:BURBANK
Suffix:
Gender:F
Credentials:PCT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4255 ROSEHILL RD
Mailing Address - Street 2:3
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-2560
Mailing Address - Country:US
Mailing Address - Phone:214-875-7957
Mailing Address - Fax:
Practice Address - Street 1:4255 ROSEHILL RD
Practice Address - Street 2:3
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-2560
Practice Address - Country:US
Practice Address - Phone:214-875-7957
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-12-14
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide