Provider Demographics
NPI:1205472719
Name:TALBOT, CAROLINE EVA (APRN FNP-C)
Entity type:Individual
Prefix:
First Name:CAROLINE
Middle Name:EVA
Last Name:TALBOT
Suffix:
Gender:F
Credentials:APRN FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10105 BANBURRY CROSS DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144-6646
Mailing Address - Country:US
Mailing Address - Phone:702-765-5437
Mailing Address - Fax:702-240-7268
Practice Address - Street 1:10105 BANBURRY CROSS DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89144-6646
Practice Address - Country:US
Practice Address - Phone:702-765-5437
Practice Address - Fax:702-240-7268
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-19
Last Update Date:2019-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV818065208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1205866381Medicaid