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General NPI Number Information
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NPI Number | 1003229386
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Entity Type | Individual
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Provider Name | ANNA BULLOCK NNP
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Gender | Female
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Dates
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Enumeration Date | 06/04/2014
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Last Update Date | 05/17/2021
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Provider Practice Location Address
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Address Line | 2609 BLAKE ST
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City | AUSTIN
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State | TX
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Zip | 78748-3950
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Country | US
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Telephone | 512-923-1509
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Fax |
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Provider Business Mailing Address
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Address Line | 6401 LLANO STAGE TRL
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City | AUSTIN
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State | TX
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Zip | 78738-6199
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Country | US
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Telephone | 512-923-1509
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LN0000X
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Taxonomy Name | Neonatal Nurse Practitioner
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License Number | AP126653
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License Number State | TX
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