Provider Demographics
NPI:1760982680
Name:PAVLIC, JUSTIN DANIEL (FNP, RN)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:DANIEL
Last Name:PAVLIC
Suffix:
Gender:M
Credentials:FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1874 S FM 1194
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-4724
Mailing Address - Country:US
Mailing Address - Phone:936-465-8491
Mailing Address - Fax:
Practice Address - Street 1:1874 S FM 1194
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-4724
Practice Address - Country:US
Practice Address - Phone:936-465-8491
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX900610163W00000X
TX1126699363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse