Provider Demographics
NPI:1275052631
Name:NICOLAS, FANIA MARIA (FNP)
Entity Type:Individual
Prefix:
First Name:FANIA
Middle Name:MARIA
Last Name:NICOLAS
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 1:9812 SLIDE RD
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-5781
Mailing Address - Country:US
Mailing Address - Phone:806-725-9128
Mailing Address - Fax:806-725-8499
Practice Address - Street 1:9812 SLIDE RD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-5781
Practice Address - Country:US
Practice Address - Phone:806-725-9128
Practice Address - Fax:806-725-8499
Is Sole Proprietor?:No
Enumeration Date:2017-09-15
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134710363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily