Provider Demographics
NPI:1639793730
Name:DVORAK, CAROL JANE (NP)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:JANE
Last Name:DVORAK
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 1:4351 BOOTH CALLOWAY RD STE 101
Mailing Address - Street 2:
Mailing Address - City:NORTH RICHLAND HILLS
Mailing Address - State:TX
Mailing Address - Zip Code:76180-7398
Mailing Address - Country:US
Mailing Address - Phone:817-284-1165
Mailing Address - Fax:817-284-4990
Practice Address - Street 1:4351 BOOTH CALLOWAY RD STE 101
Practice Address - Street 2:
Practice Address - City:NORTH RICHLAND HILLS
Practice Address - State:TX
Practice Address - Zip Code:76180-7398
Practice Address - Country:US
Practice Address - Phone:817-284-1165
Practice Address - Fax:817-284-4990
Is Sole Proprietor?:No
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230697363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX230697OtherNURSE LICENSE