Provider Demographics
NPI:1629711817
Name:DAVILA, NICOLE RENEE (APRN-CNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:RENEE
Last Name:DAVILA
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:RENEE
Other - Last Name:WALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3202 S 27TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-6222
Mailing Address - Country:US
Mailing Address - Phone:325-704-3365
Mailing Address - Fax:
Practice Address - Street 1:3202 S 27TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-6222
Practice Address - Country:US
Practice Address - Phone:325-704-3365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-15
Last Update Date:2023-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1074858363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner