Healthcare Provider Details

I. General information

NPI: 1982376711
Provider Name (Legal Business Name): NICOLE VESELITS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2021
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 W SLAUGHTER LN STE 300
AUSTIN TX
78748-1774
US

IV. Provider business mailing address

6811 OLD BEE CAVES RD APT 2210
AUSTIN TX
78735-8385
US

V. Phone/Fax

Practice location:
  • Phone: 512-277-6643
  • Fax:
Mailing address:
  • Phone: 216-469-6796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15012
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: