Provider Demographics
NPI:1871185033
Name:DOUGLAS, KARLA DANIELA
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:DANIELA
Last Name:DOUGLAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1432 WESTVIEW LN
Mailing Address - Street 2:
Mailing Address - City:NORTHLAKE
Mailing Address - State:TX
Mailing Address - Zip Code:76226-1466
Mailing Address - Country:US
Mailing Address - Phone:940-230-8130
Mailing Address - Fax:
Practice Address - Street 1:9701 HARMON RD STE 141
Practice Address - Street 2:
Practice Address - City:FT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76177-7602
Practice Address - Country:US
Practice Address - Phone:817-306-5630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-09
Last Update Date:2023-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1029525363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care