Healthcare Provider Details

I. General information

NPI: 1548878820
Provider Name (Legal Business Name): DEBORAH MICHELLE HLAVIN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH MICHELLE GORMAN FNP

II. Dates (important events)

Enumeration Date: 07/22/2020
Last Update Date: 09/17/2024
Certification Date: 09/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4630 LONG PRAIRIE RD STE 210
FLOWER MOUND TX
75028-1964
US

IV. Provider business mailing address

4037 CRESTMONT DR
COLLEGE STATION TX
77845-2073
US

V. Phone/Fax

Practice location:
  • Phone: 469-495-9112
  • Fax:
Mailing address:
  • Phone: 979-204-5403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP142146
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: