Provider Demographics
NPI:1730199308
Name:DAVAILUS, CARMEN E (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:CARMEN
Middle Name:E
Last Name:DAVAILUS
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 LAKE DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78665-9415
Mailing Address - Country:US
Mailing Address - Phone:512-264-4007
Mailing Address - Fax:
Practice Address - Street 1:17 LAKE DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-9415
Practice Address - Country:US
Practice Address - Phone:512-264-4007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP115185363LF0000X
TX722028163W00000X
HIAPRN-315363LF0000X
HIRN-46825163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP115185OtherAPRN LICENSE
TX07077OtherPRESCRIPTION ID #
TX183965604Medicaid
TX722028OtherTX LICENSE #
TX183965605Medicaid
TX722028OtherTX LICENSE #
TX345730YL9XMedicare PIN