Healthcare Provider Details

I. General information

NPI: 1205472719
Provider Name (Legal Business Name): CAROLINE EVA TALBOT APRN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2019
Last Update Date: 11/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10105 BANBURRY CROSS DR
LAS VEGAS NV
89144-6646
US

IV. Provider business mailing address

10105 BANBURRY CROSS DR
LAS VEGAS NV
89144-6646
US

V. Phone/Fax

Practice location:
  • Phone: 702-765-5437
  • Fax: 702-240-7268
Mailing address:
  • Phone: 702-765-5437
  • Fax: 702-240-7268

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number818065
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: