Provider Demographics
NPI:1750547741
Name:KARLSON, MARIA STANOVIC (FNP-C)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:STANOVIC
Last Name:KARLSON
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:
Other - Last Name:STANOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-C
Mailing Address - Street 1:PO BOX 841656
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-1656
Mailing Address - Country:US
Mailing Address - Phone:903-531-5000
Mailing Address - Fax:
Practice Address - Street 1:5414 S BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-1335
Practice Address - Country:US
Practice Address - Phone:903-581-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2017-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF335596-1363LF0000X
TXAP128125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03051407Medicaid
TX353154302Medicaid
TX353154303Medicaid
NYA400062231OtherMEDICARE PTAN
TXP01570036OtherRAIL ROAD MEDICARE
TXP01569231OtherRAIL ROAD MEDICARE
TX353154304Medicaid
TX353154301Medicaid