Provider Demographics
NPI:1629324678
Name:DAVILA, NICHOLAS AARON (FNP-C)
Entity Type:Individual
Prefix:
First Name:NICHOLAS
Middle Name:AARON
Last Name:DAVILA
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SADDLE RDG
Mailing Address - Street 2:
Mailing Address - City:CIBOLO
Mailing Address - State:TX
Mailing Address - Zip Code:78108-4357
Mailing Address - Country:US
Mailing Address - Phone:210-748-6563
Mailing Address - Fax:
Practice Address - Street 1:1310 MCCULLOUGH AVE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-5601
Practice Address - Country:US
Practice Address - Phone:210-757-2280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-27
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX760287363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily