Provider Demographics
NPI:1962838284
Name:DELVILLE, CAROL LYNN (PHD, APRN, ACNS-BC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:DELVILLE
Suffix:
Gender:F
Credentials:PHD, APRN, ACNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4107 MEDICAL PKWY 210
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3738
Mailing Address - Country:US
Mailing Address - Phone:512-451-4488
Mailing Address - Fax:512-453-2707
Practice Address - Street 1:4107 MEDICAL PKWY 210
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-3738
Practice Address - Country:US
Practice Address - Phone:512-451-4488
Practice Address - Fax:512-453-2707
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-18
Last Update Date:2015-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX661885364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health