Provider Demographics
NPI:1548427156
Name:ABULOC, TIMONET B (NP)
Entity Type:Individual
Prefix:
First Name:TIMONET
Middle Name:B
Last Name:ABULOC
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 1:2605 CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75043-0901
Mailing Address - Country:US
Mailing Address - Phone:214-714-0117
Mailing Address - Fax:469-298-3335
Practice Address - Street 1:2605 CHESAPEAKE DR
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75043-0901
Practice Address - Country:US
Practice Address - Phone:214-714-0117
Practice Address - Fax:469-298-3335
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX513568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1934309Medicaid
TX8F10271Medicare PIN