MEDICARE: MS. NICHOLA HARLAN NURSE PRACTITIONER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2100X	Acute Care Nurse Practitioner	AP125717	TX
2	363LG0600X	Gerontology Nurse Practitioner	AP125717	TX
3	363LF0000X	Family Nurse Practitioner	608438	TX

General Provider Information

NPI Number	:	1104213750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NICHOLA HARLAN NURSE PRACTITIONER

Provider Business Mailing Address
First Line	:	2003 WALSBROOK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-2436
Country	:	US
Telephone Number	:	830-980-5038
Fax Number	:

Provider Business Practice Location Address
First Line	:	2003 WALSBROOK
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-2436
Country	:	US
Telephone Number	:	830-980-5038
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/22/2015
Last Update Date	:	10/26/2016

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