Provider Demographics
NPI:1689815797
Name:CARCOBA, DORA MARIA (ACNP)
Entity Type:Individual
Prefix:MRS
First Name:DORA
Middle Name:MARIA
Last Name:CARCOBA
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 RIM RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79902-3667
Mailing Address - Country:US
Mailing Address - Phone:915-532-4542
Mailing Address - Fax:915-532-1163
Practice Address - Street 1:101 RIM RD
Practice Address - Street 2:SUITE 300
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79902-3667
Practice Address - Country:US
Practice Address - Phone:915-532-4542
Practice Address - Fax:915-532-1163
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX596064363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX205285401Medicaid
TX8L12695Medicare PIN