Healthcare Provider Details

I. General information

NPI: 1831070580
Provider Name (Legal Business Name): MR. NICHOLAS CORCORAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2025
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 RED RIVER ST
AUSTIN TX
78712-1918
US

IV. Provider business mailing address

1710 RED RIVER ST
AUSTIN TX
78712-1918
US

V. Phone/Fax

Practice location:
  • Phone: 512-471-7913
  • Fax:
Mailing address:
  • Phone: 512-471-7913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SC0200X
TaxonomyCritical Care Medicine Clinical Nurse Specialist
License Number2026073666
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number1125491
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: