Provider Demographics
NPI:1629322599
Name:MENDEZ, NICOLE RENEE (NP)
Entity Type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:RENEE
Last Name:MENDEZ
Suffix:
Gender:F
Credentials:NP
Other - Prefix:MRS
Other - First Name:NICOLE
Other - Middle Name:RENEE
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:419 MONTE VISTA DRIVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75223
Mailing Address - Country:US
Mailing Address - Phone:281-799-7663
Mailing Address - Fax:
Practice Address - Street 1:7777 FOREST LANE
Practice Address - Street 2:A-307
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230
Practice Address - Country:US
Practice Address - Phone:972-566-4866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-31
Last Update Date:2019-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX729962363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care