Provider Demographics
NPI:1306818679
Name:FALOLA, FLORENCE OLABISI (NP)
Entity Type:Individual
Prefix:MS
First Name:FLORENCE
Middle Name:OLABISI
Last Name:FALOLA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16931 MOUSE TRAP DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-5409
Mailing Address - Country:US
Mailing Address - Phone:512-246-9705
Mailing Address - Fax:
Practice Address - Street 1:3101 GOVALLE AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-3020
Practice Address - Country:US
Practice Address - Phone:512-926-7871
Practice Address - Fax:512-928-9366
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-02
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP113211363L00000X
TX612717163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1711889Medicaid
TX1711889Medicaid
Q24734Medicare UPIN