Healthcare Provider Details

I. General information

NPI: 1245287150
Provider Name (Legal Business Name): NANCY A DASSO FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12221 MOPAC EXPRESSWAY NORTH
AUSTIN TX
78758-2483
US

IV. Provider business mailing address

12221 MOPAC EXPRESSWAY NORTH
AUSTIN TX
78758-2483
US

V. Phone/Fax

Practice location:
  • Phone: 512-901-4009
  • Fax: 512-901-3909
Mailing address:
  • Phone: 512-901-4009
  • Fax: 512-901-3909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number645932
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number645932
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: