Provider Demographics
NPI:1740084037
Name:WOLF, MADISON (FNP-C)
Entity type:Individual
Prefix:
First Name:MADISON
Middle Name:
Last Name:WOLF
Suffix:
Gender:
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:460 BASTROP HWY S APT 810
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-4329
Mailing Address - Country:US
Mailing Address - Phone:214-284-9020
Mailing Address - Fax:
Practice Address - Street 1:4315 JAMES CASEY ST
Practice Address - Street 2:UNIT 105 & 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-383-9752
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-03
Last Update Date:2025-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF01251156363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily